How Digital Care Can Help Prevent Costly, Invasive and Unnecessary Procedures

It's time for a new solution that focuses first on prevention and management.

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Marko Geber/ Getty Images
Marko Geber/ Getty Images

Nobody enjoys walking through the glaring white lights of a hospital while their loved one is being rolled into the operating room or cardiac catheterization lab. For the patient and their family, it comes with immense stress, fear, anxiety, missed work, high costs, and the agony of wondering if they will make it through without complications.

For most patients, cardiac procedures are life-saving and the only way to treat certain heart conditions. But in far too many other cases, these costly, invasive, and risky procedures could have been completely avoided by patients through a greater emphasis on preventative care— also saving their families from the anxiety and fear that comes with worrying about their loved ones.

What if there was a way to reduce the need for invasive and avoidable procedures (and the high cost associated with them), while at the same time improving patient experience, quality of life, and health care outcomes? It may sound like wishful thinking, but it can be a practical reality through digital care.

Waste in the U.S. health care system

The fact that the U.S. health care system is wasteful hardly qualifies as breaking news. But what may come as a shock is just how much is wasted: $935 billion per year, or 25% of total medical spending.

What is driving this vast and growing waste? There are several factors, but over-treatment has been on the usual suspects list for decades. Over-treatment in the U.S. is estimated to cost $75.7 billion to $101.2 billion per year. It can include avoidable surgeries, invasive procedures, diagnostic testing, imaging, and prescriptions. In addition to driving excess cost, waste in health care is also increasingly being recognized as a cause of patient harm.

Ounce of prevention, pound of cure

Let’s take a closer look at an area that is responsible for an alarming volume of over-treatment: cardiovascular care. Cardiovascular disease is the leading cause of mortality in the United States for both men and women and the most expensive chronic condition, costing about $363 billion each year. Hypertension is one of the most important risk factors for development of cardiovascular disease, and early detection and management of it can be key to catching risk in time and potentially saving lives.about:blank

Among patients with hypertension, 79% do not have adequate control of their blood pressure, putting them at risk of suffering from progressive cardiovascular disease and undergoing invasive procedures that could have been avoided. But the cornerstone of health care in the U.S., the fee-for-service system, misaligns incentives by placing greater emphasis on expensive procedures and therapies rather than focusing efforts on prevention. In some cases, the fee-for-service construct has also contributed to fraud, waste, and abuse.

Stents are one of the most common procedures performed in cardiac patients. But are they always necessary? In certain settings, accumulating clinical evidence suggests otherwise. Several research studies and clinical trials have shown that patients with non-acute and stable coronary artery disease who received stents had no significant difference in clinical outcomes with respect to mortality or risk of major adverse cardiac events, compared to patients who only received medication and lifestyle intervention. One study found that a staggering 1 in 7 stent procedures for patients with stable heart disease and minimal symptoms are unnecessary.

Invasive treatments don’t come cheap. The average cost of a stent procedure is $32,200, and the average cost of coronary artery bypass grafting surgery is $151,271. While many of these procedures are appropriate and life-saving, in many cases they are potentially avoidable and may not result in better clinical outcomes or survival. Reducing avoidable and unnecessary procedures would translate to billions of dollars in health care spending each year.

The human toll of over-treatment

Consider a patient about to undergo cardiac stenting. Imagine the stress and anxiety they are feeling. Fear of complications is not unjustified. There’s a 1-2% chance that a blood clot will form — which increases the risk of heart attack or stroke.

Now imagine that their procedure was one of the 1 in 7 unnecessary stents. How would you feel if you found out that all the stress, pain, and risk from a stenting procedure you had could have been avoided? While invasive procedures may be required and remain a possibility, they should be considered a last resort instead of a first option.

Patients who are convinced that stenting or surgery are the only options in all clinical scenarios – when credible peer-reviewed medical research suggests otherwise – are the real victims of over-treatment. Their pain and suffering may not show up on a spreadsheet, but it’s absolutely real.

The problem of adherence

For managing high blood pressure, the American Heart Association and American College of Cardiology recommend medication and lifestyle management. According to Dr. Sanjeev Aggarwal M.D., System Chief of Cardiovascular Surgery and Clinical Innovation Officer at Beaumont Health, and Medical Advisor at Hello Heart, “Invasive procedures and surgeries without the corresponding changes in lifestyle and evidence-based medical therapies ultimately leads to the need for reintervention and more procedures downstream.” Healthy habits and preventative care can help patients avoid costly treatments. But this remains a challenge when patients don’t comply with lifestyle modifications and take their medications.

Traditional disease management and blood pressure tracking programs have tried — and largely failed — to fix this. Fortunately, there’s an innovative, technology-led approach that’s making a big difference: digital care.

The way forward: Digital care

Employer-sponsored insurance is the most common type of health coverage in the U.S., with more than 181 million Americans—virtually half of the population—depending on it. Employers are in a powerful position to improve quality of care while helping reduce waste in the health care system by offering digital care as an employee benefit.

Digital care bridges the gap between self-care and traditional care, empowering patients in their own health care journey. It does this through highly personalized, clinically based digital coaching and medication reminders that are securely delivered to patients. There are four pivotal advantages:

Patients can achieve better outcomes at lower costs by reducing the need for expensive and avoidable procedures. Hello Heart data suggests that 84% of its users with a baseline blood pressure over 140/90 reduced their blood pressure and sustained it up to three years.

The clinical outcomes translate into significant savings. In an independent review by Validation Institute’s population health scientists of a matched control study, they verified a cost savings of $1,865 per Hello Heart participant in the first year, or 19% of total medical claims spending. The substantial cost savings is largely the result of enabling participants to focus on positive lifestyle changes, medication adherence, and preventative care, while avoiding expensive surgeries, imaging, and ER visits, and having shorter hospitalizations.

  • Interventions that focus on prevention and management can help catch serious risk in time by providing early detection of hypertensive crises and irregular heartbeats, and allow people to potentially avoid the complications of advanced heart disease, invasive procedures, and surgeries,
  • Patients get practical and jargon-free education to understand their condition, which promotes lifestyle change and enhances self-care. P atients are better able to understand what they actually mean — and feel empowered instead of intimidated.
  • The “shame barrier” is eliminated. Patients interact with AI-driven digital coaching through their smartphone instead of having to go into a doctor’s office.

Changing the game

High spending in the U.S. health care system from over-treatment and lack of prevention is enormous and growing. If you had the chance to avoid the bright white hallways of a hospital and the physical, emotional, and financial cost of a cardiac procedure, wouldn’t you? It’s time for a fresh new solution that responsibly reduces health care costs by minimizing unnecessary and avoidable procedures to significantly reduce claims costs, while improving health outcomes for patients — potentially saving their lives. This solution is digital care, and it’s changing the game.

Originally published on www.benefitspro.com

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