What health conditions do you spend most on?

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You have to know where the problem exists before fixing it.

We did some heavy digging into where we spend healthcare dollars from one of the largest sets of publicly available data.  JAMA released one of the most comprehensive studies in 2016 on healthcare spend combining insurance claims, government budgets, official US records, etc. It combined 183 different sources of data and looked at 155 conditions from 1996 - 2013.  We dug into to the details based on 2013 data to find out what we spend on and focused on those individuals ages 20 - 64, the age of most employees.

Summary of highlights: 

  1. The most surprising; highest spend category came from mental health, largely driven by individuals under the age of 44
  2. Ambulatory setting or outpatient care was the highest site of care we spend on
  3. Musculoskeletal was the third largest area, however largest spend area (by far) if you combine it with " unintentional injury" which contains mainly musculoskeletal injuries
  4. Medication spend was highest for patients over the age of 44 and having diabetes.  Those commercials with the bathtubs and awkward beach walks mean something
  5. Buckets of spending were 20 - 44 and 45 - 64 which represented significantly different health costs when broken out by condition and site of care.  When looking into the 65+ it completely skews the data because of such high costs!

Breaking down health conditions and their percentage of overall spend (ages 20-64)

Mental Health: 11.78%
Diabetes: 11.31%
Musculoskeletal: 9.91% (combined with Unintentional Injury: 16.92%)
Unintentional Injury: 7.01% 
Cardiovascular: 7.29%
Treatment of Metabolic Risk Factors: 6.45%
Neoplasms (cancer): 5.61%
Pregnancy/Newborn: 7.00%

This is just the tip of the iceberg, knowing where you spend is the first step.  Site of care is another space to identify different spend trends.  The analysis is not rocket surgery and I am sure many organizations out there can do this.  The most important thing we find in our conversations with large employers is how to find solutions that impact these numbers. Tangible and realized quality and financial improvements.    

Value or Quality = Outcomes / Cost

We spend all of this money, how do we prove it actually makes a difference in peoples lives.  You will benefit from these and realize how to bring these data points to your employees and the proper solutions to use focusing on value, quality and financial savings.

Next week we will cover value based care and the role of the employer. We hope to provide a different lens to what everyone else has written about today.

You can sign up for our blog by entering your email in our form (once you scroll down).  If you have further questions email info@mddirectco.com, we would gladly take any topic suggestions!

Here is the JAMA study: https://jamanetwork.com/journals/jama/fullarticle/2594716
Link to the data from University of Washington: https://vizhub.healthdata.org/dex/

Article Citation: Dieleman JL, Baral R, Birger M, et al. US Spending on Personal Health Care and Public Health, 1996-2013. JAMA. 2016;316(24):2627–2646. doi:10.1001/jama.2016.16885


2018 Employer Healthcare Benefit Trends

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The National Business Group on Health just released their 2018 Trends to Watch.  This is consistent with our conversations with leaders today.  

The top trends are focused on value based contracts, leveraging technology to deliver care, the slow death of wellness programs and linking healthcare strategy to business performance.  

  • High value networks (Centers of Excellence) and ACOs are expected to grow 50%
  • Bundled payments are popular and account for 21% of COE arrangements
  • Telehealth is gaining traction with utilization rates climbing to 8% utilization (still seems low)
  • Employee experience with the healthcare system is much more important, focusing on high tough services and medical decision support
  • Point-solution fatigue is a factor now as solutions all are aimed at small areas and employers are struggling to aggregate
  • Wellness programs are fading
  • Opiod epidemic is causing employers to question their role and plan design to be a factor.

To find out more about this release check out the link to their site.