Reducing One Habit Could Potentially Decrease America's Hefty $7 Trillion Healthcare Expenditure
In the realm of American healthcare, a significant portion of spending is considered waste due to inefficiencies. This waste, amounting to billions of dollars annually, is attributed to various factors such as supply chain problems, price variations without corresponding quality improvement, and lack of price transparency.
One unexpected culprit of waste is the physician's pen. A single admission order or "just-in-case" test can incinerate $30,000, making it the hospital's most expensive equipment.
Approximately 30% of national health spending is considered waste, including redundant scans, fraud and abuse, avoidable ER visits, complex billing systems, and more. To combat this, several strategies are being proposed.
Patient navigators and expert advisory teams can help reduce avoidable emergency department use by more than 40%, freeing up beds and balancing budgets. Creating an escalation path for healthcare needs, such as PCP for routine or chronic issues, urgent care for same-day but moderate problems, telehealth for quick guidance on minor issues, and ER for time-sensitive events like chest pain or stroke symptoms, can help contain costs.
"Conscious Care Consumption" is a promising approach to address these waste drivers. It aims to implement technologies and better data-sharing systems to streamline supply chains, promote price transparency legislation and tools, encourage the use of lower-cost care settings like ambulatory surgery centers, and foster informed decision-making among consumers, providers, and payers.
For instance, asking whether anything clinically changed before repeating imaging or lab tests can help avoid unnecessary duplication and costs. Adding a surcharge to non-emergency ER trips can discourage unnecessary use and encourage members to seek care in more appropriate settings. After-hours symptom spikes can often wait for a PCP visit or telehealth consultation, reducing the need for immediate and costly interventions.
Moreover, a pre-agreed action plan can help keep treatment decisions proportional to the severity and urgency of the moment, trimming interventions and preserving outcomes. Navigating the healthcare system poorly, with multiple specialists for one issue, results in unnecessary costs. Automatic enrollment in 90-day mail-order prescriptions can help members save on pharmacy costs, with a portion of the savings returned to employees.
Fear and anxiety can lead to unnecessary hospital work-ups and inflate healthcare bills. Nearly 40% of emergency visits are not true emergencies, leading to unnecessary costs and longer wait times. Rewarding employees who choose a primary care provider and complete an annual visit can incentivize preventative care. A durable relationship with a primary care physician can help reduce unnecessary tests and non-emergent ER trips.
Lower co-pays for primary care visits can signal where health plans want members to begin seeking care. Stack manufacturer coupons or assistance programs on top of specialty drugs for additional cost savings. The U.S. health system is projected to spend $7 trillion this year, which is more than 31% of the GDP within a decade. Over-reliance on high-cost care, such as ER visits for minor issues, contributes to the rising healthcare costs.
In conclusion, conscious care consumption offers a promising solution to reduce waste in the American healthcare system. By implementing strategies like streamlining supply chains, promoting price transparency, and encouraging the use of lower-cost care settings, we can substantially reduce waste and bring down the overall cost of healthcare.
