It’s not news that health care costs are rising. But did you know that a handful of costly, complex conditions are driving a quarter of the total health care spending in the United States?1
Four condition categories are responsible for driving roughly $455 billion dollars in costs: cancer, cardiovascular disease, musculoskeletal conditions and kidney disease. These conditions account for nearly one-quarter of U.S. health care spending. The cost of care for populations with complex conditions is enormous.
What’s driving this upward trend?
Three main factors contribute to the rising cost of complex conditions:
- Variability in care practice and region: Complex conditions have a wide range of treatments and require multiple sites of care, which can contribute to varied practice patterns and outcomes.
- Pharmaceutical costs: New drugs significantly impact the cost trend, driving costs upward in categories like oncology and musculoskeletal conditions.
- Comorbidities: Increasing rates of obesity, diabetes and hypertension contribute to higher costs in managing kidney disease.
How can payers and employers curb this trend?
A comprehensive strategy is needed to control the high costs associated with complex conditions. Implementing the following four strategies will support your cost containment efforts and ultimately improve the care experience for complex patients:
- Care management: Highly-trained nurses with years of condition-specific experience help patients through every step of their care journey.
- Utilization management: Provider oversight and referrals to qualified facilities to help patients get the right care at the right time.
- Network management: Qualified Centers of Excellence significantly impact health outcomes and reduce total cost of care.
- Focused claims review: Medical reviewers help ensure that claims are paid correctly by performing a comprehensive review of complex claims.
A new webinar from OptumHealth highlights research on the economic rise of complex conditions and steps that payers and employers can take to manage populations with these conditions.
Watch the webinar to learn more.
About the author
Jon Friedman, MD, FAST
Chief Medical Officer of Medical Benefit Management, Optum
Jon Friedman, MD, FAST is the Chief Medical Officer for the Optum Medical Benefit Management business. He has clinical oversight and responsibility for Transplantation, Chronic and End Stage Kidney Disease, Bariatric Surgery, Ventricular Assist Devices, Congenital Heart Disease, Complex Cancer, and Spine/Joint Solutions.
He has been with Optum for 19 years. Prior to becoming CMO for Medical Benefit Management, Dr. Friedman spent six years with Optum as the National Medical Director of Transplants and Congenital Heart Disease. He was PacifiCare’s Medical Director of their National Preferred Transplant Network from 2001 to 2007