Going Below the Surface E-newsletter: January 2019

A new year usually brings new resolutions. We resolve to continue our efforts to dig deeper on health spending issues and better understand what’s driving spending across all sectors of health care. We encourage you to share articles, events and other comments with us — don’t be shy! Tweet using #GoingBelowTheSurface or drop us a line.

Digging Deeper

What’s the Bang for the Buck?

Is spending on health care a good thing in the long run? A study in Health Affairs this month suggests that yes, spending on medical interventions over a 20-year time period was both cost-effective and a source of high value creation, at least for six of the seven most prevalent diseases of the past two decades. The study was unique in that it controlled for two critical factors: increases in the inflation rate and prevalence of disease. When those two factors are considered, the per-person amount spent in the United States actually fell for four of the seven leading causes of death and sickness studied.

Why It Matters: Getting health care spending under control is important, but it requires understanding the right places to cut. Take heart disease: The new study found that spending on this condition has more than doubled in the past two decades, but the number of patients with heart disease has quadrupled even as the cost of treatment for patients has dropped significantly on an inflation-adjusted basis. Looking only at the topline number would suggest we despair — and misallocate resources — rather than recognize our progress against the nation’s biggest killer. The study suggests that considering each disease individually, rather than engaging in broad and poorly targeted cost-cutting, is likely to have the greatest impact on reducing spending while encouraging innovation and health gains.

Do You Really Need an MRI?

CT scans, MRIs and other diagnostic imaging tools are innovations that enable us to look inside to pinpoint and diagnose diseases or issues we couldn’t before. But studies have shown that these tools are often overused in medical care and frequently detect “incidentalomas” – something unexpected and unrelated to the original reason for screening. Armed with this “extra” information, what happens next takes an unnecessary toll on both patients and the health care system. Physicians often order additional tests or treatments, adding to a patient’s stress and anxiety levels; more tests also have financial consequences for our health care system. Research published in JAMA this month suggests that both physician and general public education campaigns can help reduce unnecessary screenings. Another approach is to limit imaging scope to a very specific area, reducing potential “incidentalomas.” And “proper studies, in particular randomized controlled trials, should be supported to examine how to curb unnecessary and wasted imaging,” wrote the study authors.

Why It Matters: Limiting imaging has been among the suggestions to reduce wasteful and unnecessary care offered by the Choosing Wisely campaign, which “seeks to advance a national dialogue on avoiding unnecessary medical tests, treatments and procedures,” but it’s clear that more efforts are needed in this area. Overuse of imaging equates to haphazard screening of individuals for disease, and there is no evidence showing that these screenings improve overall population health.

What We’re Reading in the Journals

The choices that we make, whether at the individual or health system level, affect overall costs to the health care system. Costs also are affected by market forces within a specific geographic area. Let’s take a closer look at these factors via peer-reviewed journal articles.     

• Activating Employees in Discussions of Health Care Trade-Offs: It Can Be Done. McNichol J, Nichols L, Buelt L, Ciarametaro M, Dubois RW. January 3, 2019, Health Affairs Blog. Policymakers should not assume that U.S. consumers are unwilling to discuss or prioritize health care benefits within a constrained budget; using a deliberative process or framework can facilitate these decisions. Engaging employees in a discussion of health care prioritization could increase buy-in and satisfaction in their employer-sponsored health benefits.
   
• Complacency Slows Aggressive Approaches to Health Care Cost Containment: A View From Three Markets. Corlette S, Hoadley J, Keith K. December 14, 2018, Health Affairs Blog. “Local geography, longstanding personal and professional relationships, the involvement of unions, the varying types of employers, and insurance market concentration” were key factors in whether and how providers exercised market clout and how payers responded to demands for higher reimbursement.

Dialogues on Health Care Spending

Health spending remains a hot topic in 2019, with congressional committees examining health care costs, a continued look at reducing inappropriate care and organizations coming together to consider creative financing approaches. Check out these upcoming events and register online to reserve your spot.

• Register today for the Jan. 25 webinar, “Too Much Medicine: Addressing Inappropriate Care,” hosted by the National Institute for Health Care Management Foundation. Experts will discuss approaches to curbing unnecessary medical treatments and spending, new research on this topic, and strategies and models that can be used to improve care.
   
• The FDA is approving more targeted and curative therapies, but these complex treatments are often more expensive. MIT’s NEWDIGS FoCUS project brought together a diverse group of health care experts to determine how to finance these curative therapies. During the Feb. 12 Paying for Cures conference, speakers will outline the financing challenges of curative therapies, share precision financing strategies and tools, and explore solutions to making cures accessible to patients and sustainable for the health care system. Keynote speakers include U.S. Senators Bill Cassidy (R-La.) and Sheldon Whitehouse (D-R.I.).

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About Going Below the Surface

The Going Below the Surface initiative was launched by the National Pharmaceutical Council in 2018 to broaden and improve the conversation around how health care resources are used in the United States. The initiative is aimed at better understanding the roots of the nation’s health spending and investments by promoting a discussion that is firmly based in health policy and systems research. Our goal is to provide clarity on how best to optimize health care spending so that patients receive the right care while simultaneously providing the right incentives to sustain next-generation innovation to improve patient well-being and health system efficiencies.

To view the Going Below the Surface partners, visit www.goingbelowthesurface.org.

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