How to save $18 billion in health care costs

The health care crisis. It’s an issue that tops Minnesotans list. Last year, Minnesota spent an average of $6,500.00 on out of pocket medical expenses. In 1970, we spent about $390.00 annually. What if there was a way to cut between $8 and $18 billion off that number? What if, while doing it, we could help work on healthier Minnesotans and fight abuse and neglect? The Academy on Violence and Abuse thinks they can do just that.

Founded in 2005 by a group of concerned health care professionals, the national office is based in Eden Prairie. Members of the AVA banded together after they started to notice that their chronic patients had histories that included violence. Several had been abused as children, and many more had experienced some form of violence in their lives.

“It started for me when I was a family doctor in Chanhassen. I got patients to talk about what had been going in their lives. And it directly contributed to why they were in my office.” says David McCollum, an emergency room physician in Eden Prairie. McCollum found that the patients that experienced abuse or neglect in their lives visited his office about 2 1/2 times the normal rate. After talking to a friend doing a fellowship in chronic pain, he asked that a question be added to the intake questionnaire. What they found was shocking. 100% of those chronic pain patients polled had a history of violence or abuse. And whether it was physical, emotional, sexual, or mental abuse, the outcome was still the same. These people had longstanding physical issues. Dr. McCollum set out to find if those findings were a fluke, or if there was something more going on.

Dr. McCollum explains, the brain and the body are hardwired to deal with acute stress episodes. When there’s danger, or stress, our bodies can react to all those chemicals that flood our system and deal with them appropriately. But when the body has to deal with a stressful situation day in and day out. It just can’t handle the chemical overload. And the body just finds other ways to cope.

The medical community seems to agree. In 2002, the U.S. Institute of Medicine issued a report chastising the medical community for not doing more to prepare physicians to identify abuse and help patients manage the effects. And this past spring, U.S. congress finally passed policy requiring insurance companies to treat mental health diagnoses as they do physical ailments.

The Academy’s mission seems simple enough: if you identify the root causes of chronic conditions, you can more effectively treat the symptoms. They would like to see doctors spend a few extra minutes with each patient and ask them the hard questions.

“Overall, most people are willing to talk,” says Dr. McCollum. “But they generally say that they’ve dealt with it. That’s often times not the case.” And the extra time he spends only amounts to a few extra minutes. “We can get to the root of most problems in about 20 minutes. Sometimes it’s longer, but it doesn’t matter to me. My charge isn’t going to be any more if I take 10 minutes or an hour.”

Unfortunately, doctors are simply not trained to look for underlying issues. If the AVA gets its way, all that will change. The academy has released what they call a “blueprint” for medical schools. They would tomorrow’s doctors taught to identify and treat issues stemming from long-term abuse and neglect. They estimate if we start to treat the underlying issue as well as the immediate concern it could cut Minnesota spending by billions. That’s more money to cover more Minnesotans. It’s a better quality of life for people with pervasive problems that send them to the doctor dozens of times more often than the average Minnesotan. And it’s quite a goal.

Minnesota has been a pioneer in the medical field for a long time. The rest of the country often looks north for the latest innovations in the medical field. By adding coursework into the curriculum at our top-notch teaching hospitals, we could truly make a difference in the lives of all Minnesotans. As Minnesota goes, hopefully America will follow. We simply can’t afford not to.