Latest / Becker’s Healthcare Podcast / Strategies for Reducing the Total Cost of Care: Part 1

Transcript

Strategies for Reducing the Total Cost of Care: Part 1 · Becker’s Healthcare Podcast

• 0:00
  Welcome everyone to a special edition of the
• 0:02
  Becker's Healthcare podcast series. Today, we'll be diving
• 0:05
  into a conversation with Sierra Garvin, the senior
• 0:08
  associate director of Above Brand Marketing at Behringer
• 0:11
  Ingelheim,
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  and Manny Leonard, senior director of drug use
• 0:14
  policy and formulary management at Cleveland Clinic as
• 0:18
  featured on Behringer Ingelheim's In Focus podcast.
• 0:21
  We hope you enjoy this special episode.
• 0:29
  Hello, and welcome to series three of the
• 0:31
  InFocus podcast brought to you by Boehringer Ingelheim.
• 0:34
  If you haven't already listened to the first
• 0:36
  two series on population health management and transitions
• 0:39
  of care, make sure to check them out
• 0:41
  at strategiesforqualitycare.com.
• 0:43
  Today, you're listening to the first of four
• 0:46
  episodes, which focuses on strategies for reducing the
• 0:49
  total cost of care, a growing concern for
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  health care organizations today.
• 0:53
  I'm Sierra Garvin, senior associate director of Above
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  Brand Marketing, and I'll be your host for
• 0:58
  this series.
• 1:00
  It's widely recognized that the high cost of
• 1:02
  health care in The US is unsustainable
• 1:05
  and disrupts economic stability
• 1:07
  with negative consequences
• 1:09
  for our patients, payers, health systems,
• 1:11
  industries, and society,
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  even causing some patients to forego needed health
• 1:16
  care.
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  To reduce the total cost of care, it's
• 1:19
  important to understand the drivers of health care
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  expenditures
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  and to adopt innovations that reduce costs
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  without reducing care quality.
• 1:28
  As we dive into the discussion of cost
• 1:31
  and strategies in this series, we'll be joined
• 1:33
  by four subject matter experts who will share
• 1:36
  information about the causes and impact of high
• 1:39
  health care costs and the ways to reduce
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  them.
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  We'll also hear about real world approaches
• 1:45
  that can help reduce the total cost of
• 1:47
  care.
• 1:48
  These subject matter experts are Mandy Leonard, senior
• 1:51
  director of drug use policy and formulary management
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  at Cleveland Clinic,
• 1:57
  doctor Nihar Desai, an associate professor of medicine
• 2:00
  and vice chief of the section of cardiovascular
• 2:03
  medicine at Yale University School of Medicine,
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  doctor Andrew Freeman,
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  director of clinical cardiology and cardiovascular
• 2:11
  prevention and wellness at National Jewish Health, and
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  Kim Newlin, a cardiovascular
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  nurse practitioner and clinical performance improvement consultant at
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  Sutter Health.
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  For this first episode, we'll talk with expert
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  Mandy Leonard to explore the systemic and disease
• 2:27
  related drivers behind high health care costs.
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  Welcome to the series, Mandy, and thank you
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  for joining us.
• 2:34
  Hi, Sierra. Thanks for having me.
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  Mandy, with your background and experience managing drug
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  related costs for twenty five years at the
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  Cleveland Clinic, could you start by providing us
• 2:44
  with an overview of health care spending?
• 2:47
  Certainly.
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  To begin with, The US spends more on
• 2:50
  health care than any other nation.
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  For example, health care spending accounted for nearly
• 2:56
  18%
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  of our GDP in 2023,
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  and spending is expected to grow almost 6%
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  from 2023
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  to 2032.
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  The federal government is responsible for nearly one
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  third of health care expenditures.
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  And what's most unfortunate
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  is that despite our larger expenditures,
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  The US ranks behind other countries in key
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  health metrics,
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  such as life expectancy,
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  obesity rates,
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  infant mortality, and hospital admissions for diabetes.
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  That's really surprising that despite the large expenditures,
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  The US ranks behind other countries in key
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  health metrics.
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  So what's driving this significant increase in the
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  cost of health care?
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  Well, some of the biggest drivers are the
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  increasing age of the population,
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  high hospital readmission rates, and patients who are
• 3:45
  high utilizers of health care.
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  For example, the portion of the population age
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  65 and older is increasing,
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  and projections suggest they'll account for more than
• 3:55
  twenty percent of the population in 2032.
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  And in terms of high utilization,
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  just 5% of The US population is responsible
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  for nearly half of all health care spending.
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  Older adults and those with serious chronic illnesses
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  are some of the biggest users of health
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  care, and they require more frequent and costlier
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  treatments.
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  I can understand how these factors would contribute
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  to the increase in cost, especially with chronic
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  conditions.
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  Could you share more about the role that
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  chronic conditions play in driving up costs?
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  Absolutely.
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  According to a report for the Centers for
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  Disease Control and Prevention,
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  about ninety percent of US healthcare spending involves
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  chronic and mental health conditions,
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  and about sixty percent of Americans have at
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  least one chronic disease.
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  Additionally, patients with chronic diseases account for the
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  vast majority of hospitalizations
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  and filled prescriptions.
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  Wow. Chronic diseases and mental health conditions seem
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  to account for an extremely large portion of
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  health care spending.
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  Do modifiable risk factors play a role in
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  this?
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  They sure do. Modifiable risk factors play a
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  significant role in chronic diseases.
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  In one study, some of the modifiable risk
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  factors that were associated with the highest spending
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  were high body mass index,
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  high systolic blood pressure,
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  high fasting plasma glucose,
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  dietary risks, and tobacco smoke.
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  Most of the spending related to these risk
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  factors was in patients aged 65 and older.
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  In the same study,
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  certain chronic conditions were found to have health
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  care costs that could be attributed to modifiable
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  risk factors.
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  These included
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  musculoskeletal
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  disorders,
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  chronic respiratory diseases,
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  digestive diseases,
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  mental health and substance use disorders, and neurological
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  disorders.
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  Are those the most costly chronic conditions?
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  That's a great question.
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  All chronic conditions contribute to high health care
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  expenditures,
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  but cardiovascular
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  diseases,
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  cancer,
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  diabetes,
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  chronic kidney disease, and autoimmune diseases
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  are among the most common and costly.
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  Let me present some facts to you.
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  First,
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  cardiovascular diseases are the leading cause of death
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  and cost over $250,000,000,000
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  annually to treat. And secondly,
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  more than a hundred and thirty five million
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  Americans are living with diabetes or prediabetes,
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  resulting in the astounding annual cost of $413,000,000,000
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  Those are staggering numbers.
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  If someone has multiple chronic conditions, does the
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  impact also multiply?
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  Most definitely.
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  Having multiple chronic conditions leads to worsening patient
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  outcomes and higher costs.
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  Managing chronic conditions is difficult and costly, and
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  over fifty five percent of Americans have multiple
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  chronic conditions or what we'd call MCCs.
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  These are associated with higher mortality rates, as
• 6:56
  well as reduced health related quality of life,
• 7:00
  increased health care use, and costs.
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  It's unfortunate that so many Americans suffer from
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  multiple chronic conditions.
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  What are some of these combinations, and why
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  are they so expensive to treat?
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  Some of the most common and expensive combinations
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  include diabetes,
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  cardiovascular diseases, including heart failure and hypertension,
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  as well as chronic obstructive pulmonary disease.
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  The most expensive two way combination is heart
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  failure and cardiovascular
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  diseases,
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  which is associated with annual medical costs of
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  over $30,000
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  per patient.
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  Other costly MCC combinations
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  include cardiovascular
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  disease with diabetes,
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  arthritis, asthma,
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  or chronic obstructive pulmonary disease.
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  An additional costly combination includes diabetes with either
• 7:49
  depression or anxiety.
• 7:52
  The high costs are due in part to
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  the complexity
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  of treating multiple conditions simultaneously.
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  This typically involves prescribing several medications
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  and following various and sometimes conflicting clinical practice
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  guidelines,
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  which can often complicate treatment decisions and lead
• 8:09
  to poor long term outcomes.
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  One potential solution is for the experts to
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  develop joint clinical guidelines
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  for some of the most common MCC combinations.
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  It would be great to see that happen.
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  Are there any other conditions that have a
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  high cost burden on health care?
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  There certainly are. Rare diseases also contribute to
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  high expenditures.
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  A rare disease is any disease that affects
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  fewer than two hundred thousand patients.
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  While the population that has each of these
• 8:40
  diseases is small,
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  the collective population is estimated at 25 to
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  30,000,000 since there are up to nearly 10,000
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  rare diseases.
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  In In one study, the economic burden of
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  rare diseases was estimated to be nearly $1,000,000,000,000
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  And this estimate was only based on the
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  associated costs of just under 380
• 9:00
  rare diseases.
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  So it doesn't account for all of the
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  rare diseases.
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  The economic burden created by the direct cost
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  for rare diseases is $449,000,000,000
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  And the indirect cost burden isn't far off
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  from that at $437,000,000,000
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  Since a rare disease may increase the chances
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  of having a severe functional impairment or disability
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  that can actually prevent patients from gaining work
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  and staying employed, indirect costs are primarily driven
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  by productivity and opportunity losses.
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  That's a tough reality for many.
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  Are there reasons outside of disease states that
• 9:40
  contribute to the rising cost of health care?
• 9:43
  Well, that's another great question, Sierra, and the
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  answer is yes. A significant portion of health
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  care spending is wasteful,
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  which is defined as spending that can be
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  reduced
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  or eliminated without adversely affecting the quality of
• 9:56
  care or health outcomes.
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  A review article published by JAMA in 2019
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  found that wasteful spending accounted for about 25%
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  of all health care expenditures
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  at that time.
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  To expand further on wasteful spending, the main
• 10:11
  drivers are called out as six different domains.
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  The first is failure of care delivery.
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  This includes hospital acquired conditions and adverse events,
• 10:21
  clinician related inefficiencies,
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  and the lack of adoption of preventative care
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  practices.
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  Second is failure of care coordination.
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  This category includes unnecessary admissions,
• 10:33
  avoidable complications,
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  and readmissions.
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  The third category is overtreatment or low value
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  care,
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  which includes low value medication use,
• 10:43
  low value screening, testing, or procedures,
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  and overuse of end of life care.
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  Fourth is pricing failure.
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  This includes medication,
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  laboratory,
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  outpatient, and payer based health service pricing failures.
• 10:58
  Fifth, there's fraud and abuse, including in Medicare.
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  And lastly, there's administrative complexity.
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  This final category includes billing and coding waste
• 11:08
  and physician time spent reporting on quality measures.
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  Interventions have been proposed to address this wasteful
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  spending, and it's been estimated that they would
• 11:17
  reduce the total cost of waste by about
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  25%.
• 11:22
  Wow. Clearly, there is a lot to do
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  to help reduce health care expenditures.
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  We thank you, Mandy, for joining us today
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  and providing a comprehensive review of what drives
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  these costs.
• 11:33
  And thanks for having me, Sierra. I truly
• 11:35
  enjoyed spending time with you today.
• 11:37
  It's been a great discussion. Thank you.
• 11:41
  As you've heard from our discussion today, preventing
• 11:43
  the total cost of health care from continually
• 11:46
  increasing presents a major challenge.
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  Fortunately, the challenge is being taken up by
• 11:51
  organizations that are adopting newer methods that help
• 11:54
  reduce costs without impacting
• 11:56
  care quality.
• 11:58
  With that, we encourage you to join us
• 12:00
  for our next episode, where we discuss value
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  based care and the opportunities this method provides
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  to reduce overall health care costs.
• 12:10
  Together, we can make a meaningful impact on
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  the future of health care.
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  Thank you for joining us.
• 12:27
  Thank you, Sierra and Mandy for your time
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  and insights today. And we also wanna thank
• 12:31
  our podcast sponsor, Boehringer Ingelheim.
• 12:33
  You can tune in to more podcasts from
• 12:35
  Becker's Healthcare by visiting our podcast page at
• 12:37
  beckershospitalreview.com.