Childhood Diabetes Rates and Costs Climb

childhood diabetes employer health costsChildhood diabetes rates are on the rise, and a report released Monday pointed to the impact that the cost of their care could have on families — even those who have employer-sponsored health insurance.

The study, conducted by the Health Care Cost Institute (HCCI), found that children as old as 18 with diabetes who were insured through an employer-sponsored plan racked up $2,173 per capita in out-of-pocket health care costs in 2014. That spending level was nearly five times higher than that of kids without the illness.

The HCCI researchers analyzed data from claims submitted from 2012 to 2014 through group, individual and Medicare Advantage insurance policies to analyze health care spending and utilization trends among people younger than 65 who had diabetes and employer-sponsored coverage plans.

In terms of use of medical services, children with diabetes visited the emergency room 2.5 times more often than children without it. Acute inpatient services were used nearly five times more often. In all, a year’s worth of care cost $17,380 — the second only to adults aged 55 through 64 with diabetes.

Although more prescriptions and frequent doctor’s visits help explain the difference inchildhood diabetes rates cost the health care costs generated by children with and without this illness, researchers were still surprised by the magnitude of the disparity.

Families are “spending more out-of-pocket across the board on all types of services,” said Amanda Frost, a senior researcher at HCCI. “And it’s just higher use. So when you end up using all of these health care services, you end up with a very personal impact on your wallet, especially if you’re a parent with a child with diabetes.”

(Kaiser Health News, Heredia Rodriguez June 20, 2016)

Kaiser Health News






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Saving Health Costs: A Case Study

It is possible to save on health care costs. Here’s how.

savings hospital admissions health costs

Between 1999 and 2015, employer-sponsored health premiums rose 203%.i Deductibles for workers have mushroomed faster than both income and premiums. Businesses have struggled to find ways to contain these costs while providing for their employees.

This graph, “Health Plan Savings for One Employer,” is a real-life illustration of how wise management based on data analysis has saved millions of dollars for a MedCost client over the past five years.

When this client came to MedCost in 2010, hospital admissions were 87 per 1,000 covered lives. Without any changes in plan design or benefits, the MedCost clinical team ensured that patients received thorough follow-up care to avoid readmissions after joint replacements, cardiac and back surgeries and other procedures.

Skilled nurse managers helped schedule doctor visits and asked questions such as: “Are you taking all your meds? Is there anything you don’t understand about your care?”pregnancy, pregnancies, high risk pregnancy, health costs

Board-certified case managers and highly specialized obstetrical nurses focused on early identification of high-risk pregnancies, offering tips for prenatal care. Sometimes they interacted with doctors’ offices to help families get the answers they needed.

MedCost nurse health coaches worked with patients suffering chronic conditions such as high blood pressure, diabetes, migraines or congestive heart failure, helping them reduce symptoms, close gaps in care and comply with treatment plans.

The result? Better health for patients, and increasingly lower costs for employers. Since 2011, this employer has enjoyed five consecutive years under budget for health plan expenditures—as a result of data analysis and managing the right care at the right time through MedCost Care Management programs.

It is possible to save on health care expenses, using the right partner to manage employee health effectively. If you would like more information about this case study, please contact Jason Clarke at jclarke@medcost.com.

 

[1] “Recent Trends in Employer-Sponsored Health Insurance Premiums,” Kaiser Family Foundation, January 5, 2016, http://kff.org/infographic/visualizing-health-policy-recent-trends-in-employer-sponsored-health-insurance-premiums/ (accessed June 16, 2016).

 

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Hospital Costs Surge with Increased Opioid Abuse

Every day, headlines detail the casualties of the nation’s surge in heroin and prescription painkiller opioid drugsabuse: the funerals, the broken families and the patients cycling in and out of treatment. Now, a new study sheds light on another repercussion — how this public health problem is adding to the nation’s ballooning health care costs and who’s shouldering that burden.

The research comes as policymakers grapple with how to curb the increased abuse of these drugs, known as opioids. State legislators in New York,Connecticut, Alaska and Pennsylvania have tried to take action by adding new resources to boost prevention and treatment. In addition, President Barack Obama laid out strategies last month intended to improve how the health system deals with addiction.

Published Monday in the journal Health Affairs, the study measures how many people were hospitalized between 2002 and 2012 because they were abusing heroin or prescription painkillers, and how many of them got serious infections related to their drug use. It also tracks what hospitals charged to treat those patients and how the hospitals were paid.

(Kaiser Health NewsShefali Luthra, May 2, 2016)

Kaiser Health News

 

 

Health Premiums Growing Faster than Income

Single Employee Insurance Up 48% from 2005-2014

It’s no surprise to employers that health premiums continue to take a bigger spending bite every year. Single employee premiums jumped 48% from 2005 to 2014, reported the Congressional Budget Office (CBO) in February 2016.[i] Estimates at 5% annual growth mean that the cost of insuring employees will outpace average income per capita by two percentage points per year.

health expenses, healthcare costs, employer premiums

Source: CBO with data from 2015 Employer Health Benefits Survey (Kaiser Family Foundation) & Agency for Healthcare Research & Quality

The CBO projects average premiums for employer-based coverage at $10,000 for individuals and about $24,500 for family coverage in 2025—an almost 60% increase from 2016.

Costs for government subsidized health insurance will top $600 billion this year. And most Americans who receive subsidies are working full-time. The Affordable Care Act (ACA) will account for $110 billion in subsidies.

Looming over employers is the Cadillac tax on more expensive health care insurance. Currently the 40% tax is set to take effect in 2020 (see “Cadillac Tax Revisions” blog), but ACA requirements are impacting employer planning for health benefits.

Since an average 62% of American employees still get their health coverage at work, tracking health care spending remains a major concern for businesses.[i]health premiums, healthcare costs, employer health expenses

As health care laws continue to change, employers must work closely with consultants and benefits administrators who have expert knowledge to get the best performance from every health care dollar.

[i] “Update from 2015 Employer Health Benefits Survey,” Kaiser Family Foundation, February 5, 2016, http://kff.org/private-insurance/issue-brief/a-comparison-of-the-availability-and-cost-of-coverage-for-workers-in-small-firms-and-large-firms-update-from-the-2015-employer-health-benefits-survey/ (accessed April 28, 2016)

[i] “Private Health Insurance Premiums and Federal Policy,” Congressional Budget Office, February 11, 2016, https://www.cbo.gov/publication/51130 (accessed April 4, 2016).

 

US Drug Spending Up 8.5% in 2015

Increases Due to Rising Prices and Prescriptions Filledpills, drugs, medicine, opioids, health costs

U.S. spending on prescription drugs rose 8.5 percent last year, slightly less than in 2014, driven mainly by growing use of ultra-expensive new drugs and price hikes on other medicines.

A report from data firm IMS Health estimates patients, insurers, government programs and other payers spent a combined $309.5 billion last year on prescription medicines.

The IMS Institute for Healthcare Informatics is forecasting that annual increases in U.S. prescription drug spending will slow to 4 to 7 percent through 2020, after rising around 10 percent in each of the past three years. It predicts spending will reach $370 billion to $400 billion in 2020.

(Associated Press, April 14, 2016)

Telemedicine: Doctor on Call

TelemedicineLooking for a way to save on health care? It might be as close as your cell phone.

Which medical facility do you choose when you have the flu? A sprained ankle? Headaches? Your health plan may now include telemedicine—video or phone conferences with a board-certified doctor, within minutes of a call. You may be able to save the costs of Emergency Room (ER) or Urgent Care visits for a wide variety of common ailments(see “Treatment Alternatives” below). 

A Truven Health Analytics’ study reported that 71% of ER visits are unnecessary.[i]  Urgent care facilities now treat a number of minor illnesses and ailments. And the rapidly growing use of telemedicine means that even remote rural areas can get expert consultations with board-certified physicians.

Compare these costs from the study:

 Average ER Visit Average Primary Care Doctor Visit Average Telemed Consultation*

 $1,316

$145

$40-$50

*Consult your summary plan description for complete coverage details

Need a better prescription for your health care expenses? The expert care of local physicians may be available with a phone call, no matter where you are.

TREATMENT ALTERNATIVES TO THE EMERGENCY ROOM

Telemedicine

[i] Sabrina Rodak, “Study: 71% of ED Visits Unnecessary, Avoidable,” Becker’s Hospital Review, April 25, 2013, http://www.beckershospitalreview.com/capacity-management/study-71-of-ed-visits-unnecessary-avoidable.html (accessed February 23, 2016)

 

Reducing Health Costs with Data

Analysis Reveals Better Care Options, Less Cost 
reducing health costs with data

(Source: Kaiser Family Foundation)

In the past six years, health premiums have increased by 203%, reported a recent Kaiser Family Foundation study.[1] But workers’ earnings grew an average 56% during that period. How can employers better manage health care dollars?

The surge of sophisticated technology for big data analysis gives providers and employers unprecedented opportunities to target potentially unnecessary costs, while better caring for covered members.

Consider this example: Jane,* a 42-year old female member with moderately-controlled diabetes, has health benefits through her job. Jane’s biannual visit to her Primary Care Physician (PCP) documents her routine lab work, prescriptions and referrals for preventive screenings.

Between PCP visits, this diabetic member gets the flu, causing severe increases in blood glucose levels. When Jane goes to the Emergency Room, the ER doctor increases her medication dosage. After she goes home, Jane’s personal blood glucose meter shows an alarming drop in her blood sugar levels. Jane calls her PCP, who adjusts her dosage to prevent more complications. Jane’s next checkup is planned in six months.

Was all the data communicated from the hospital’s electronic records, the lab vendor’s system, payer claims and her home monitoring glucose meter? Will the PCP be able to verify that Janreduce health expensese actually obtained her preventive mammogram or flu vaccine prescribed before the ER visit?

At MedCost, Jane’s case would be carefully monitored by her nurse health coach. If there is an issue, her nurse health coach would follow up.

Big data equips providers to accurately analyze key metrics to do more than explain past diagnoses and trends in a group of employees. Advanced analytics can now identify patients and populations at risk for developing certain conditions prior to the actual onset of illness.

It is possible for employers to save on health expenses. Harness the power of accurate data analysis to preserve medical costs, while benefiting your employees’ health.

 

*Actual patient data not used.

[1]Journal of American Medical Association, 2016; 315(1);18, doi:10.1001/jama.2015.17349, http://bit.ly/1TSOFho (accessed Feb. 15, 2016)

 

2015 MedCost Care Management Outcomes (Infographic)

save health care plans, cut costs, health insurance

Avoid These Common Data Mistakes

The United States wastes $275 billion annually on health care spending through inefficient record-keeping, duplicated files, fraud or abuse, according to Truven Health Analytics. Nearly $9,000 per second is lost on illegible writing, incomplete entries or inaccurate interpretations of data.[i]

Graph.iStock_000022706119XSmall

In this era of massive data generation, how can companies ensure accurate analyses of their employees’ population health? Here are four common data mistakes to avoid:

1. Making business decisions based on “uncleansed” data.

Electronic health records today overflow with complex treatments, prescriptions, lab results and other tests. Incorrect synthesis of these outcomes can obscure a 360-degree view of past medical history and future potential problems.

MedCost creates detailed reporting with Deerwalk software to help clients identify both medical and financial trends. Sophisticated analytics identify areas of data where misinterpretation may occur. When data is integrated and “scrubbed,” employers may then be assured of making accurate decisions based on those results.

 2. Assuming that claims are processed correctly.

Data integrity is key to avoiding skewed results. Were monthly premiums accidentally included in claim expenses? Have claims been duplicated? Were pharmacy costs integrated with the right patient’s claim?

No one would try to calibrate a car’s multiple computer systems without the right training and equipment. Not using standard query entries will produce data sets of unreliable results for financial and medical decisions. The company that manages your health plan benefits should do rigorous quality assurance audits before releasing “cleansed” data to you.

3. Failing to use technology to protect your group of covered members.

The operating rule of today’s digital health care is that if it can’t be measured, it can’t be managed. How can a company uncover excessive medical costs or emerging health issues for employees, unless clinical and claims data is tracked?

Smart businesses track profit and loss columns. Smart businesses also keep a close eye on cost trends to reduce medical spend and improve population health for employees. MedCost as a benefits administrator delivers monthly reports with specific cost analyses and recommendations to each of our clients.

4. Ignoring cost trends that are wasting your health care dollars.

Health care, despite the tsunami of data generated, is still about people. How can an employer know when an employee’s blood pressure is out of control? When blood glucose levels have gone sky-high? When prescribed meds are no longer being taken? Without careful
analysis of gaps in care, expensive treatments won’t be avoided. And employee health conditions may worsen that could also have been prevented.

Are these data mistakes costing your company thousands of dollars? Consider using quality analysis by a reputable benefits administrator to clarify complex data, while managing population health and more efficient health care spending.

For more information on benefit solutions, contact Jason at MedCost.

[i] “Claims Audit Solutions,” Truven Health Analytics™, http://truvenhealth.com/portals/0/assets/emp_12181_0113_auditsuiteoverviewbrochure.pdf (accessed November 9, 2015).