Be Anti "Un-Impactable"

I've been waiting - too long - to share this message. This will be the first post in a series about why I decidedly reject the population health dogma of the "un-imapctable" - and why you should too. This is a bit out of order in my planned series, but fortunately, an article was published in the current issue of Annals of Internal Medicine that has moved me out of planning and into sharing mode. Here it goes. If this resonates, please join me in eliminating the anti-equity notion that groups of patients are "un-impactable" and thus do not merit the investment of health systems and ACOs to provide innovative high value care by sharing your stories and evidence using #antiunimpactable and #healthequity.

Lesson 1: It is possible to reduce readmissions for patients with substance use disorder. Do not systematically exclude this group of patients from your ACO/hospital readmission reduction programmatic efforts. Design a program that is matched to meet the population's needs.

Evidence: Jan Gryczynski and team from the Friends Research Institute in Maryland published a randomized controlled trial in April 2021 issue of Annals of Internal Medicine. The team randomized 400 hospitalized adults with comorbid SUD to "proactive case management, advocacy, service linkage and motivational support to resolve internal and external barriers to care and address SUD, medical and basic needs." Impact: patients in the program had a 15% 30-day readmission rate vs patients receiving standard care had a 30% readmission rate. Wow! That is a BIG impact!

Context: This was a high-utilizing group of people. This was a group of people with "complex needs" - because their needs included more than "just medical" - and included SUD, behavioral and social needs. This was a group of 400 people who would have typically been excluded from many hospital-based readmission reduction and/or ACO case management programs across the US - possibly because of "active SUD," possibly because of "high utilizer" status, or possibly because of their various social needs, such as lacking a phone or unstable housing.

Take-Away: Un-impactable is not a feature of the person, or of a patient population. Un-impactable is a limitation of the service that is being delivered. If a group of patients is not effectively served by the service, the *service model* is what is lacking - the patients remain in need of effective help. I particularly note the description of the intervention as "proactive" - this is on-point and key success factor. Bravo to the researchers - and thank you for being anti-unimpactable!