Lost In Translation

We’re all different and so is the care, cost, and delivery of healthcare we receive, unfortunately. Our latest report explains why.

Everybody is unique.

National Geographic covers The Future of Medicine and told us, “A new era of healthcare is coming.” It’s called precision medicine, and it looks at genetics, the environment and a person’s lifestyle to determine the most effective treatment. What if we could predict which chemotherapy will be most effective with the least side effects? What if we could pinpoint a genetic disposition for heart disease and avert illness with proactive lifestyle changes? What if we could tailor treatments across the board?

It’s already happening. And the promising ability to deliver the right care to the right person at the right time will change the way we manage health and wellness benefits. The more we know, the more effectively we can communicate, encourage, and deliver benefits that address employees’ needs and reduce costs.

Last month, Health Action Council released our fifth annual white paper, Costly conditions: Identifying and addressing top clinical cost drivers. In partnership with UnitedHealth Group, UMR and Optum, we identified the most costly conditions, top cost drivers, and analyzed why each was so expensive. What we learned is where employees live affects health, provider billing patterns, and employer spend.

Bottom line: There are many variances in community care and billing. The quality of care your employees receive might depend on their address. The price you pay for benefits is also linked to community. Here are some findings from the report that speak to the fact that everybody is different. And when we capture data and tailor care, we can achieve better outcomes and lower costs. We can push for better care.

Here are some highlights you might be interested in as you evaluate benefits.

The Cancer Disparity
Women have a 52% higher prevalence of cancer claims than men, and the difference is driven by breast cancer. Cancer claims are higher in individuals with annual incomes of more than $75,000. There are more than 200 types of cancer with an average total cost of care ranging from $100,000 to $200,000. Of those totals, 18% is attributed to chemotherapy, amounting to a $74,000 per patient cost. Scientific advancement comes at a cost. We also learned that the provider billing depends on the community and can cost three times more depending on where you live.

Correlating Obesity and Joint Replacement
The need to have a joint replacement is 9 to 33 times higher for individuals with a body mass index of 30 or higher. And again, billing varies by location. Those who live in Dallas, Houston and San Antonio will pay up to five times more for knee imaging than individuals who live in Cleveland or Pittsburgh.

Linking Depression and GI Issues
Of employees suffering from irritable bowel syndrome, 87 percent will miss work due to symptoms and fatigue—and this exacerbates anxiety. But what we might not think about is the link between GI and depression. Those with celiac disease can feel isolated from others because of a restrictive diet that eliminates gluten. And aside from depression, comorbidities include hypertension, back disorders, diabetes, and high lipids.

Neurological Therapy vs. Surgery
A surprising data point uncovered in the white paper is a huge rift in carpal tunnel care based on geography. Patients in Greensboro, S.C., are eight times more likely to get surgery than patients in Phoenix. And the cost of care is four time higher in Los Angeles than Philadelphia. With neurological conditions in general, those with lower incomes are less likely to seek and receive care.

Take Action – Control Costs and Elevate Care
When we reveal disparities in care and cost and work to understand our employee populations, we can select healthcare benefits and wellness programs that align with their needs. But beyond this, we must speak the language—communicate in ways our teams can understand the data and how they can utilize benefits to improve their overall health.

As we move toward the New Normal for medicine and healthcare benefits, precision medicine is on the near horizon. In some respects, it’s here. For instance, genetic testing can help direct which chemotherapy will be the most effective.

We encourage you to read the white paper—and let us know how the action steps we outline will influence the way you deliver benefits programs and support your people. We look forward to hearing from you!

About Health Action Council 
Health Action Council is a not-for-profit 501(c)(6) organization representing mid-and large-size employers that enhance human and economic health through thought leadership, innovative services, and collaboration. It provides value to its members by facilitating projects that improve the quality and moderate the cost of healthcare purchased by its members for their employees, dependents, and retirees. Health Action Council also collaborates with key stakeholders – health plans, physicians, hospitals, and the pharmaceutical industry – to improve the quality and efficiency of healthcare in the community.