Waste in Healthcare
One reason why this has happens is because of the information imbalance that can exist between healthcare purchasers and healthcare providers: simply put, healthcare provider organizations know much more about healthcare quality than buyers. This informational asymmetry significantly increases the likelihood that buyers will end up purchasing a lemon.
A fractional Chief Medical Officer can help healthcare purchasers create benefit strategies that nudge members to pursue high value care.
Diagnostic error is “common, costly, and harmful,” and has been labeled as a major public health problem that affects every one of us.
Providing care that is not needed is rampant. An analysis using the Milliman MedInsight Waste Calculator identified a “handful of health care services” that accounted for millions of dollars in waste. 73% of women had Pap smears performed too frequently. 74% of imaging for eye disease was not needed.
Healthcare purchasers spend more than $25 billion on five specific types of wasteful spending.
High value care is based on an accurate diagnosis and is evidence based. Healthcare purchasers are well positioned to use tools such as Choosing Wisely to reduce healthcare waste.
Low-value medication use occurs in many ways:
Clinician prescribing more expensive medications that offer not clinical advantage over less expensive medications (can account for up to 24% of pharmacy spend for self-insured plans)
Patient non-adherence to medications they have purchased
Clinician prescribing medications when not needed (a State of Washington analysis revealed 98% of antibiotics prescribed for URI or ear infection were not needed).
High-value medication spend occurs when members take drugs that improve health outcomes, and are obtained in the most cost-effective and convenient way. Many tools exist to identify and promote appropriate prescribing practices.
Members benefit when providers:
Partner with patients to create customized treatment plans that are adjusted as needed to achieve desired outcomes
Guide patients through the healthcare system, preventing a “perilous journey”
Refer patients to the highest quality specialists when needed
Members can achieve better clinical outcomes at lower costs when lifestyle changes are adopted long-term. The presence of vendors promising “wellness” solutions without verifiable results requires careful evaluation.
Links
https://www.healthaffairs.org/do/10.1377/hpb20121213.959735/full/
https://www.linkedin.com/pulse/we-measuring-value-primary-care-david-claud-md-phd/
https://www.improvediagnosis.org/what-is-diagnostic-error/
https://www.wacommunitycheckup.org/media/47156/2018-first-do-no-harm.pdf
https://www.medscape.com/viewarticle/705334