The benefits of thinking inside the box

Thinking outside the box has become a truism. It is meant to convey creativity and thinking beyond the obvious. Yet boxes serve a purpose. When we categorize and classify people with similar addressable conditions or overall medical complexity, we can more easily and effectively deliver the right solutions. 

Sometimes categorizing people is helpful, and sometimes it isn’t. Clinical classification categories are helpful for understanding the health needs of a population. Even better is when these categories include social determinants of health (SDoH), since they can account for 50-80 percent of a population’s health status. 

Classification by disease status, such as type II diabetes, is helpful if there is a known treatment or intervention that can improve patient outcomes, quality or cost. For example, further categorizing diabetic patients with an elevated HbA1c level and reported food insecurity allowed the Geisinger Health System to target individuals to receive a “Fresh Food Pharmacy” program to achieve a 20 percent decrease in HbA1c levels. Furthermore, every point decline in HbA1c levels resulted in approximately $8,000 of health care cost savings. These results would not have been nearly as impressive if all persons with diabetes participated regardless of HbA1c level or food insecurity. 

It would be convenient if patients only had to manage only one chronic condition. However, a greater proportion of U.S. adults have two or more chronic conditions (27.2 percent) and not just one (24.6 percent). Treating children with medical complexity is also a significant challenge, considering that three percent of the pediatric Medicaid population accounts for 40 percent of health care costs. Identifying children in the highest risk groups can be achieved using a variety of methods, including complex chronic condition (CCC) categories, clinical risk group (CRG) software, the Agency for Healthcare Research and Quality (AHRQ) Chronic Condition Indicators (CCIs) and Seattle Children’s Hospital Patient Medical Complexity Algorithm (PMCA). 

Thinking outside the box has its place, but thinking inside the box allows us to focus scarce resources on addressable conditions. Being inside the box does not mean that everyone is the same. Nor does it mean that those inside the box are different in all ways from those outside the box. It simply means that they share attributes with others which could make them more likely to benefit from a program, intervention or treatment that addresses their particular situation. 

Ultimately, we are all unique. However, since the human mind has a natural tendency to organize and classify, we should encourage “inside the box” thinking when it results in improved outcomes, cost savings and a better experience for the patient. 

Steve Delaronde is senior manager of product, population and payment solutions at 3M Health Information Systems.