We all know health care costs continue to increase year over year, often by more than 5 percent. But what if I told you that right now, approximately 6 percent of your clients’ medical spend was on just five common surgeries? What if I went on to tell you that as often as half of the time, these surgeries may not be needed, according to medical evidence, and/or are not wanted by employees, who have other treatment options. This would represent an incredible opportunity to bend the cost trend and improve health outcomes.
The big brains behind the Dartmouth Atlas were among the first to clue us in that there is widespread variation in the number and types of surgeries performed across the country. For example, one major metropolitan city may have patients three times more likely to have a knee replacement, compared to another. The explanation for the difference is not the patient population — it is the surgeons. In some regions, it is more fashionable or culturally acceptable to reach for the scalpel as the first option, even when medical evidence says there are other treatment options. And, of course, in many of these cases, the patient would want a less invasive treatment option, too.
This led the Dartmouth experts to conclude, “Changing the practice of medicine so that treatment choices reflect patients’ preferences has the potential to radically change the consumption and quality of health care.”
So what does that mean for you as a benefits professional? The good news is that the more employees know about their care and treatment options, the greater the potential for savings. And even more importantly, the greater the potential they get the care they need and want, leading to better long-term health outcomes.
So how can you make this happen? Before we get to that, let’s explore why employees are having surgeries they don’t need or want in the first place. The issue is a category of medical care we call “preference sensitive care.” The term “preference sensitive care” means medical care for which the clinical evidence does not clearly support one treatment; the appropriate course of treatment depends on the values of the patient.
A good example of this is bariatric surgery. Bob may contemplate bariatric surgery for weight loss, but also have a non-surgical option to pursue a lifestyle change. Does he want to risk surgery and is he committed to the follow up? (Most patients don’t fully realize that bariatric surgeries require a significant, permanent change in diet that many find unsatisfying and difficult to manage; as a result almost 50 percent regain the weight they lose. Knowing this, maybe Bob would opt to try a lifestyle change. Hip and knee replacements, back surgery, and hysterectomies are other examples of some of the most common preference sensitive surgical procedures.
According to data from Truven Marketscan, these five surgical procedures cost an average of $27,900. In total, employers spend around $90 billion annually on these procedures and their related costs alone — and several hundred more preference sensitive procedures and surgeries exist.
Getting back to the big brains at Dartmouth, expert Dr. David Wennberg and other colleagues published a study in 2013 that showed educated patients (those who received “an unusual level of support” when making a medical decision about six different preference sensitive surgeries) had 12.5 percent fewer hospital admissions and 9.9 percent fewer preference sensitive surgeries, including 20.9 percent fewer preference sensitive heart surgeries.”
That is huge. At my organization, our proprietary internal research shows that for the five preference sensitive surgeries I mentioned above, the rate of informed patients who elect to have surgery can be even lower. And the great news is that the “level of support” required is not unreasonable. It just means some appropriate, best in class health coaching (or shared decision making).
There are many ways benefits professionals can support employee education and shared decision making. There are various vendors, and some exciting new partnerships happening with health plans. The other day, I even read about a new app designed to educate people considering back surgery.
Dr. Wennberg and his colleagues go on to explain, “The skills patients learn and the more active role they assume by participating in shared decision making may carry over to other health care interactions. One result could be broad reductions in medical costs because unnecessary treatments are avoided.”
As the old adage goes, “give a man a fish and he’ll eat for a day, but teach him to fish…” As medical providers and benefits professionals, we have a special opportunity to teach people how to be real, discerning health care consumers for life. It is an incredible opportunity to change their lives and bend the cost trend while we are at it.Cindi A. Slater M.D. is the Chief Medical Officer of ConsumerMedical. She received her M.D. from the University of Pennsylvania and is board certified in internal medicine. Dr. Slater is a Clinical Instructor of Medicine at Harvard Medical School and practices internal medicine at the Brigham & Women’s Hospital in Boston.