Some of the most expensive and avoidable costs in health care are generated after a patient leaves the hospital.
In New York, where hospital stays rank among the most expensive in the country, inpatient care averages $3,489 per day, the fifth highest in the nation — and rehospitalizations cost $3.7 billion each year. A meaningful share of that spending is tied to what happens in the days after a patient goes home.
We have to plan care better in New York
Patients often leave the hospital without a clear, connected plan for what comes next. Follow-up visits may not be scheduled. Medications can be confusing. Primary care providers may not even know their patient was hospitalized. These are not rare missteps but predictable care gaps that can send patients back to the hospital for issues
that could have been addressed earlier, at far lower cost.
In my work in population health, I’ve seen this pattern play out again and again — patients with complex needs leaving the hospital without the coordination or support they need to recover at home. Too often, they return days or weeks later, and it becomes clear the system isn’t working as it should.
This is one of the most immediate places to act to keep care affordable.
For patients managing chronic conditions such as heart failure, COPD, diabetes or cancer, the transition home is one of the most complex moments in their care. Without coordination, even small issues can escalate quickly. A missed appointment or untreated symptoms can become an emergency room visit or a hospital readmission.
That outcome is not inevitable. It is the result of care becoming disconnected when it matters most.
Across 20 hospitals in New York, our discharge coordinator team works with patients before they leave the hospital to make sure the next steps are clear and connected. The goal is simple: patients get the right care at the right time after discharge, and they have the information and support they need to recover at home.
That includes making sure primary care providers are informed, follow-up care is scheduled and patients understand what comes next and patients and families have a clear point of contact.
For example, our team worked with a patient managing heart failure, COPD and diabetes whose care was fragmented heading into discharge. By coordinating follow-up with their doctors and putting support in place at home, what could have become another hospital visit became a stable recovery with their family.
These are practical steps that address one of the most persistent drivers of healthcare cost: fragmentation across care settings.
If we connect complex care in NY, we can lower costs, improve outcomes
When care stays connected, patients are more likely to recover at home, follow up with their care team and address issues earlier in lower-cost settings. Providers can take proactive steps, managing conditions before they worsen rather than reacting after the fact.
The impact is straightforward: fewer avoidable hospital visits, lower costs for patients and less strain on the healthcare system.
Conversations around health care costs often focus on large, complex solutions. But there are also clear opportunities already in front of us:
- Better handoffs between hospital and home.
- Clear communication across care teams.
- Support that follows patients beyond discharge.
In a state like New York, where the cost of care affects patients, families and communities, these are not incremental fixes. They are foundational.
Keeping care connected after a hospital stay is one of the most direct and practical ways to reduce avoidable costs and make health care more affordable for everyone.
Lorraine Tighe is supervisor of the Population Health Discharge Coordinator Program at Optum Medical Care New York.
This article originally appeared on Rockland/Westchester Journal News: We can make health care more affordable in NY. This is how | Opinion
