It’s not news that health care costs are rising. But did you
know that a handful of costly, complex conditions are driving a quarter of the
total health care spending in the United States?1
Four condition categories are responsible for driving roughly
$455 billion dollars in costs: cancer, cardiovascular disease, musculoskeletal
conditions and kidney disease. These conditions account for nearly one-quarter
of U.S. health care spending. The cost of care for populations with complex
conditions is enormous.
What’s driving this upward trend?
Three main factors contribute to the rising cost of complex conditions:
Three main factors contribute to the rising cost of complex conditions:
1.
Variability in care practice and region: Complex
conditions have a wide range of treatments and require multiple sites of care,
which can contribute to varied practice patterns and outcomes.
2.
Pharmaceutical costs: New drugs significantly impact
the cost trend, driving costs upward in categories like oncology and
musculoskeletal conditions.
3.
Comorbidities: Increasing rates of obesity, diabetes and
hypertension contribute to higher costs in managing kidney disease.
How can payers and employers curb this trend?
A comprehensive strategy is needed to control the high costs associated with complex conditions. Implementing the following four strategies will support your cost containment efforts and ultimately improve the care experience for complex patients:
A comprehensive strategy is needed to control the high costs associated with complex conditions. Implementing the following four strategies will support your cost containment efforts and ultimately improve the care experience for complex patients:
·
Care management: Highly-trained nurses with
years of condition-specific experience help patients through every step of
their care journey.
·
Utilization management: Provider oversight and
referrals to qualified facilities to help patients get the right care at the
right time.
·
Network management: Qualified Centers of Excellence
significantly impact health outcomes and reduce total cost of care.
·
Focused claims review: Medical reviewers help ensure that
claims are paid correctly by performing a comprehensive review of complex
claims.
A new webinar from OptumHealth highlights research on the
economic rise of complex conditions and steps that payers and employers can
take to manage populations with these conditions.
Watch
the webinar to learn more.
Jon Friedman, MD, FAST
Chief Medical Officer of Medical Benefit Management, Optum
Chief Medical Officer of Medical Benefit Management, Optum
Jon Friedman, MD, FAST is the Chief Medical Officer for the
Optum Medical Benefit Management business. He has clinical oversight and
responsibility for Transplantation, Chronic and End Stage Kidney Disease,
Bariatric Surgery, Ventricular Assist Devices, Congenital Heart Disease, Complex
Cancer, and Spine/Joint Solutions.
He has been with Optum for 19 years. Prior to becoming CMO for
Medical Benefit Management, Dr. Friedman spent six years with Optum as the
National Medical Director of Transplants and Congenital Heart Disease. He was
PacifiCare’s Medical Director of their National Preferred Transplant Network
from 2001 to 2007
https://healthcare-conversation.com/2019/05/06/curb-the-trend-of-complex-costly-conditions-with-a-comprehensive-strategy/?o=optum:SM:ER_1.1_2019:li:ER:lrn:191w23704mm30
No comments:
Post a Comment