CERC'S Model for Critical Care


Critical illness is a significant driver of health care utilization in the US, with more than five million patients admitted annually to intensive care units (ICUs) and associated costs approaching 1% of the US gross domestic product. Demand is increasing, as evidenced by the growth in US critical care spending during 2000-2010 from $56 billion to $108 billion. This growth reflects increased ICU utilization, an aging population, and the rising costs of advanced therapies.

For decades, the one-size-fits-all function of the ICU was a successful and efficient means of caring for critically ill patients. But the organization of critical care delivery in the hospital has failed to keep pace with the progression of scientific knowledge and technology, which has allowed for dramatic improvements in monitoring and therapeutics.

Patients with reversible critical illness require the expertise of an ICU, yet up to 40% of current ICU patients may be “too well” to benefit from it. Yet these patients may have high labor or frequent monitoring needs that cannot be met elsewhere.

At the other end of the illness severity spectrum are millions of patients cared for in ICUs who are “too sick” to benefit from critical care, having serious illnesses and values inconsistent with ICU care. These days spent in the ICU are up to four times more expensive than days on the hospital floor and could be avoided.

CERC’s team set out to understand and design a model of ICU care delivery that would more appropriately address the needs of these patients and reduce the exorbitant costs associated with one-size-fits-all ICU care.

The team identified three major design targets that would significantly improve the value of care delivered to patients who are critically ill or at risk of becoming critically ill:

·      Solution: Prevent just-in-case ICU admissions.

·      Prevent or accelerate ICU admission for subtly deteriorating patients.

·      Prevent ICU admissions unwanted by patients near the end of life.

A conservative estimate of national savings from full implementation of the CERC model is $21 billion in direct health care spending per year, or 20% of annual spending for critical care.

Team: Meghan Ramsey, MD, Kelly Vranas MD, Jeffrey Jopling, MD, MSHS, Terry Platchek, MD, Arnold Milstein, MD, MPH