Why Avoidable ER Visits Aren't the Real Cost Problem: Revisiting Our 2016 Interview With HHS Nominee Chris Klomp

Emergency Department High Utilizers and Real-Time Care Coordination, With Chris Klomp (Episode 532)

Today we are dipping into the archives for an essential replay from 2016, one decade ago, featuring Chris Klomp back when he served as CEO of Collective Medical, and now nominated to serve as deputy secretary of the Department of Health and Human Services (HHS), a nearly $2 trillion federal health apparatus. In this conversation, Klomp explains why emergency medicine is only 2 to 4% of total U.S. healthcare cost, so avoidable ED spend can't be more than about 0.8 to 0.9% of total spend, and why the emergency department is still the natural choke point for finding complex, high-risk patients. Listening back is a rare, candid preview of the operational philosophy which may now shape Chris Klomp's view on health policy.

WHAT YOU'LL LEARN

✅ Why Klomp said in 2016 that emergency medicine is only 2 to 4% of total U.S. healthcare cost, versus about 6% for plan sponsors now

✅ How the ED works as a "clearinghouse" for physical, mental, behavioral, and social complexity, and why the goal is the right care setting, not stopping the visit (EMTALA)

✅ How a Pacific Northwest clinical group used real-time data and coordinated care plans to cut hospital readmission rates by close to 40%

✅ Klomp's four building blocks: real-time data (starting with an ADT feed, since claims data runs 90 to 180 days late), risk analytics, communication inside the EHR workflow, and community-wide collaboration

✅ How whole-person care took "Ron" from 23 ED visits in a month across seven hospitals to 3 at peak, and why 78% of ED high utilizers have physical, mental, and behavioral health comorbidities

WHY THIS MATTERS

With the nomination of Chris Klomp to serve as deputy secretary of HHS, all eyes are kind of on how he plans to manage a nearly $2 trillion federal health apparatus. The emergency department is a critical choke point through which complex, often high-risk patients inevitably pass. Not dealing effectively with these larger community issues costs everyone more than dealing with them effectively would cost, and if the country had done more of what Klomp describes ten years ago, it makes you wonder how things would be different now.

MENTIONED IN THIS EPISODE

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Study: Research from Peter Smulowitz, MD, MPH; Leah Honigman, MD; and Bruce Landon, MD, MBA

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EP473 with Kenny Cole, MD: Apple Podcasts | Spotify

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=== LINKS ===

🔗 Show Notes with all the mentioned links and article: Show Notes

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00:00 Introduction to this episode.

04:38 Reducing wasteful spend in healthcare.

05:37 The percentage of total healthcare costs that goes to emergency medical spend in the U.S.

07:09 Why ED spending is low-hanging fruit.

08:17 How EDs operate as choke points.

09:14 Impacting what happens in the emergency department.

17:34 What happens when a patient enters the ED.

20:57 Why it's important to have data available to everyone who might touch the patient.

24:45 The need-to-know when it comes to managing data.

28:01 Thinking about risk and imminent readmission.

30:01 Collaboration in a care plan to reduce wasteful spend.

30:53 The right data, risk analytics, communication, and community-wide collaboration.

31:11 How social determinants affect wasteful spend in the ED.