Both Medicaid and Medicare members struggle to obtain adequate health care, whether it’s because they face barriers surrounding access to care or don’t possess the necessary literacy skills to understand and prioritize their care needs. Cost is one factor that can often create barriers for patients, making it important for plans to navigate and overcome this challenge. Explore the costs of health care and ways to reduce them with preventative measures.
Managing the rising costs of health care
We know that quality care can add up, and costs unfortunately continue on an upward trend. Individuals with chronic conditions account for $1.5 trillion of the $2 trillion of overall annual health care spend.
So is there a solution? Preventive care lowers costs by helping plans and their members get ahead of severe problems that lead to poor health, chronic issues and even death. With it, patients can detect problems early and make lifestyle changes to manage them and prevent more serious—and costly—illnesses. A few of the many ways to manage preventive care surround maternity, mental health and loneliness-related interventions.
Maternity and newborn care
Nine months is a long time to receive ongoing care, but it benefits patients and plans in the long run. The fact is that it’s more cost-effective to care for pregnant women and newborns—recognizing and facing red flags early—than it is to deal with pregnancy complications, premature birth and other serious problems.
Mental health care
Anxiety, depression and loneliness are at epidemic levels, making early intervention vital. This is especially true of high-risk populations such as the homeless, who visit EDs approximately five times per year, costing taxpayers $18,500 per person. By supporting screening for these problems early, you open the door for members to receive appropriate care—from counseling to medication—drastically improving outcomes and costs.
Loneliness intervention
Loneliness can lead to depression, anxiety and suicidal ideation. As an often long-lasting and arguably chronic condition, it can also impact neurological and heart health. Lonely people have decreased cognitive function due to stress, contributing to dementia and cardiovascular and immune issues due to elevated cortisol. But with preventive screening, there’s an opportunity to mitigate these problems — improving physical and mental health along the way.
Mitigating major health risks burden
Remember: Cost reduction is about more than preventive care. It also means taking preventative measures surrounding both readmissions and overuse. Plans like yours are positioned to provide tools to support medication adherence, navigate SDOH needs and encourage right-time care.
Reduce readmission risk
Did you know that at least 26.9% of readmissions are avoidable? Your plan can support members post-discharge to reduce readmission and associated costs.
For one thing, frequent flyers are often nonadherent to medication regimens and treatment plans. However, you can provide the tools for recovery, such as discharge instructions so patients can manage their care at home.
Additionally, there are hints to look for about the patients themselves. You can use SDOH screening combined with technology and medical history to identify readmission risk. Both Medicaid and Medicare plans reduce overutilization and save with these measures—amounting to $846 per member per month (PMPM) in ED and inpatient costs for Medicaid plans, as well as decreasing ED and inpatient costs 61% PMPM for Medicare plans.
But you can’t undercut the value of addressing loneliness and social isolation, either. That’s because not only does it have the potential to impact physical and mental health, but also appropriate engagement in health care. If members screen high for loneliness, they’re less likely to get care at the time of need—resulting in further ED visits and readmissions. Find out early to sync them with appropriate care and reduce the risk of repeating the cycle.
Prevent overuse of low-value care and unnecessary spending
According to leaders from the Harvard T.H Chan School of Public Health and Indiana University School of Public Health and Environmental Affairs, “If more effective approaches could be identified that reduce ED as well as inpatient spending without harming patient outcomes, that would be the holy grail — improved access and quality at lower cost.”
Low-value care can include everything from diagnostic tests to imaging to ED visits. While these can be very valuable when they’re needed, members often use them when they don’t understand what they need or don’t have other options. But plans like yours can go a different route, providing access to community health workers (CHWs) and compassionate care coordinators, saving up to $4.4 billion per year.
Implement preventative measures that work
Health care costs aren’t dropping, but plans and their members have options to solve this challenge. From preventive care services surrounding specific health concerns to reducing readmission and overuse of low-value care, there’s a whole host of preventative measures to reduce high-cost services.
For our part, Pyx Health reaches plans and their members to promote wellness and provide necessary help at a member's time of need. Our innovative compassion-centered app helps you drive down costs by engaging members in stimulating activities, plus providing helpful resources. Paired with our specially-trained ANDYs, who provide not only companionship, but also advice and coordination with health plans, members get the resources they need to fully engage with their health.
Want to do more to mitigate health costs? Explore the white paper for actionable measures.
