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Starling Physicians CAN Influence the Cost-of-Care

We’ve described the work underway to document the quality of the care we provide so we can receive recognition for that work.  Now, let’s turn our attention to cost.  Broadly speaking, the most expensive components of medical care these days are facility costs (i.e., hospital days, ER visits) and pharmaceuticals.  In some cases, there are no safe, appropriate alternatives to inpatient or hospital-based care, or to the use of very expensive medications and injectable drugs. In many other cases, however, physicians can influence the total cost of care by making high quality, but less expensive alternatives available to patients.

In the near term, Starling Physicians can have a significant influence on the cost of care in the following ways:

  • Reducing Avoidable Admissions and Readmissions:
    • Reducing Avoidable ER visits – When a patient receives care in an ER that could have been provided in an outpatient setting (Starling office or Urgent Care Center), not only is the cost of the ER visit significant, but the patient is much more likely to be admitted to a hospital, leading to additional costs. Encouraging patients to call the practice when they need care, fitting them in as often as possible, and directing them to a “partner” urgent care center encourages important cultural changes in patients, and is essential to managing costs.
    • Reducing Readmissions – Health plans and payors, including Medicare, are concerned about readmissions within 30 days of discharge from hospitals and skilled nursing facilities (SNF). Hospitals are receiving financial penalties for 30-day readmissions, and Medicare will attribute readmission rates to physicians’ quality performance as well. Identifying and engaging patients as they transition to home from a hospital or admission to prevent readmissions that could have been prevented needs to be part of our focus going forward.
  • Embracing Generic Prescribing:
    • Although most of us think we are prescribing generic medications when patients can tolerate them, our data suggests we can do even better. Starling’s generic prescribing rates for: Statins (82%), Beta Blockers and Combos (88%), ARB/ARB Combos (89%) and ADHD Medications (69%) are still below those of our peers in CT, whose rates are over 90%.  Pharmacy costs make up close to 1/3 of the medical spend, so every bit of savings counts.

In most Starling agreements, if we are able to reduce costs while meeting quality goals by investing resources to redesigning care, we will share in the savings generated by those investments.