Friday, September 18, 2009

Health Care Reform, Part 3

In my last entry I started talking about the two white papers my company recently released "Federal Cost Containment - How In Practice Can It Be Done?" and Health Care Cost Containment - How Technology Can Cut Red Tape and Simplify Health Care Administration", that describe how to save hundreds of billions in health care costs starting now while improving the quality of care.

In my last blog, I detailed costs to federal health care programs such as Medicare and Medicaid. Besides saving billions in federal medical programs, we can cut billions in administrative costs throughout the entire health care system.

These administrative cost savings come from implementing three cost-saving strategies over the next 10 years:
1. Requiring that all health care insurance carriers, including government, use common technology standards and implement technology enhancements such as automated health plan ID cards and electronic fund transfers can save $225 billion.
2. Using advanced data-processing techniques to pay claims quickly and more accurately can save $87 billion.
3. Streamlining and standardizing the process of checking and rating the credentials of physicians, hospitals and other caregivers can save $19 billion.

If the federal government, health care providers and private insurance companies implement these strategies, they can play an important role in freeing up a tremendous amount of money that can be dedicated to expanding coverage to more of the uninsured and to addressing our other health care challenges. Moreover, it would go a long way toward creating a much healthier America.

Check out these two white papers. They will really open your ideas to the possibilities for improving our health care system through health care modernization.

Check the Evidence First

One of the strategies I’ve been talking about to cut health care costs is using evidence-based medicine for care management and reimbursement policies. Evidence-based medicine is the use of real-world evidence to determine what practices and treatments work best for any given medical condition.

I’ve run across a poignant example of how using evidence-based medicine cuts cost while also raising the quality of care. It turns out that 48% of all newborns admitted to NICU were delivered by scheduled caesarian (C-section) births, many taking place before the 39 weeks that physicians and almost everyone else knows is the full term during which a fetus typically grows before birth.

Medical research shows the greatest growth in the use of C-sections has been among women and their physicians opting for elective procedures, many before the 39 weeks’ gestation period ends. Why do people opt for elective caesarians? Sometimes they do it so the mother is not in the hospital on a major holiday; sometimes it’s to accommodate a vacation.

But whatever the reason that women have elective C-sections before full term, it’s bad for the baby. A growing body of recent research reveals that newborns delivered prior to 39 weeks are two-times more likely to end up in the NICU than babies born at 39 to 42 weeks. No wonder that the American College of Obstetricians and Gynecologists (ACOG) discourage C-Sections to deliver babies before full-term.

When UnitedHealthcare shared this startling data about C-sections and health problems in newborns with a pilot group of physicians and hospitals, they significantly reduced the number of elective C-sections. The result: there was a 46% decline of NICU admissions in three months, a decline that has held stable for more than a year. That’s almost half the numbers of newborns with health problems, almost half the number of distraught parents, almost half the number of potential tragedies. The cost savings to these hospitals, the parents and the health care system is enormous.

We have now launched similar communications programs with all the OB/GYN doctors and 4,800 hospitals in our national network of health care providers. And we’re also putting more about the dangers of elective C-Sections in our Healthy Pregnancy Owner’s Manual that we give to expectant parents and also on our healthy pregnancy website.

UnitedHealthcare is calling for hospitals and obstetricians everywhere to end scheduling elective C-sections unless they are positive that the procedure won’t take place until after the baby has reached full term. Note I said “elective,” because sometimes there are pressing medical reasons for a premature C-Section.

As it turns out, for many conditions there is a great variance in how different physicians treat their patients. If health care insurance companies and medical caregivers work together, we can identify from real-world evidence the best practices for a wide variety of medical conditions. As we can see in the case of elective C-Sections, using evidence-based guidelines in medical care will lead to healthier outcomes for patients.

Take Control and Save

We hunt through clearance racks to cut the cost of designer goods. We change the oil and put new tires on our cars to avoid a more costly trip to the mechanic. We spend hours online comparing and contrasting travel sites before booking our family vacations. Why can’t we take the same cost-saving approach to our health care?

No matter what happens with health care reform, consumers will have to start taking a more active role to save money on their family’s health care. There are plenty of ways for the savvy consumer to trim the dollar signs and prevent their health care costs from escalating.

Here are a couple of my favorite ways that average people can take matters into their own hands and reduce health care costs. The first two have to do with living healthy lifestyles:
· Lose weight. An apple a day is no longer the trick. Maybe because we dip it in caramel. Maybe because we don’t eat it at all. Whatever the reason, widespread obesity is driving the cost of keeping the doctor away to where it threatens to break the bank. Get to a healthy weight to avoid costly and damaging health complications. By making the effort to exercise and eat right we can save our health care dollars for any future medical conditions that can’t be prevented.

· Stop smoking. Many insurance companies now offer discounts for smoking cessation programs that help fight the addiction. Smoking is tied to serious health risks like lung cancer and emphysema that require costly treatments. The simple act of putting out that cigarette can have a significant impact on the cost of health care.

Prevention, Prevention, Prevention

Lately I’ve been thinking of ways that people can save on health care. In my last entry, I mentioned two ways to lead a healthier life, to stop smoking and lose weight. By living healthier, you need the health care system less and therefore spend less on health care.

Other ways to save money by living healthier have to do with keeping tabs on your medical condition:
· Make primary prevention a priority. Primary prevention is a proactive approach that helps cut costs by helping maintain good health in the first place. By keeping up with immunizations and going for regular check-ups you can take preventive measures to stop health problems before they have the chance to start and have a major impact on the price you pay for health care in the long run.

· Take control with secondary prevention. If you can’t keep a health condition from arising, you can still fight the cost of its effects. Secondary prevention aims for early detection and interventions that slow the progression and onset of chronic diseases such as diabetes and heart disease. Keeping up with screenings, never missing doctor visits and taking medications correctly will help minimize the cost of needing additional care.

· Know your conditions. When you make the effort to listen to your doctors, take notes and fully understand your medical conditions, you are working together with your physicians to manage your illnesses more effectively and therefore cut costs.

More in a few days!

Work Your Health Care Plan

It’s amazing how much money you can save on health care once you start to think about it. One thing I notice is that many people spend more money on their health care than they should because they don’t take the time to review their health care plan documents. Here are some suggestions:
· Understand our health benefit plan. Read the fine print, or log on to the health insurance company’s Web site. Know what is covered and what is not, and learn about any available wellness programs that can help improve health, reduce overall costs or even provide monetary incentives.

· Use in-network providers. Seeing a doctor outside of the health care plans network costs more than seeing one in-network. Most health plans have thousands of doctors in their networks. A quick visit to the insurance company’s Web site can help avoid a more costly visit to the doctor.

· Review the doctor’s bill. Making sure we have been billed correctly after an office visit or procedure is a simple routine that can save money and reduce stress.

Keep it locked…I’ll give still more cost-savings tips next time post a blog entry!

Control the Cost of Drugs

Perhaps the fastest growing factor in health care costs is the cost of filling prescriptions. Many health insurance policies have a prescription drug benefit, but both those with and without health insurance can save money if they:
· Select generic over brand-name drugs. Beside many brand name drugs on the shelf are equally effective and equivalent generic versions. Equal in everything but name recognition, these drugs offer the same level of quality, purity and strength as their brand-name counterparts and cost 30- to 60-percent less. Ask the pharmacist for a generic version and we can save substantially on our prescription medications.

· Mail it in and split it. Prescriptions delivered via the postal mail vs. buying them at retail locations may help reduce drug co-pays and even offer a 90-day instead of 30-day supply. Or consider pill splitting. By following the doctor’s instructions and using a special device to split and take only half of a pill prescribed at double the dose each time, we can save hundreds of dollars a year on medications.
Armed with the 10 suggestions I’ve listed over the last week or so, it’s now time to lace up the running shoes, go for an annual check-ups and, most importantly, know the options you have for reducing health care costs.

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