Take a look at a healthcare expenditures map, and you'll see that some regions in the U.S. spend a lot more than others. Is it because their populations are sicker? In many cases, probably not. According to researchers at the Center for the Evaluative Clinical Sciences (CECS) at Dartmouth Medical School, the wide gap in spending can actually be explained by unwarranted variation in physician practices. For example, cardiac bypass surgery rates exhibit about a fourfold range of variation, from 3 per 1,000 (adjusted for age, sex, and race) in Albuquerque, N.M., to more than 11 per 1,000 in Redding, Calif. The rates are strongly correlated with the per-capita numbers of cardiac catheterization labs in the regions, but not with illness rates as measured by the incidence of heart attacks in the region.
The Institute of Medicine suggested that “if all regions adopted the practice patterns of the most conservatively spending regions in the country, health outcomes could be significantly improved and U.S. healthcare spending could decline by as much as 30 percent.”
Treatment choices appear to be determined largely by local medical opinion concerning the value of surgery or its alternative. Health outcomes are threatened when doctors prescribe a treatment—for example, a particular surgery for chronic back pain—when there is no evidence proving positive longterm outcomes and when a less expensive treatment option, like physical therapy, is available.
One way employers can tackle this issue and help lower their own healthcare costs is to use expert medical opinion services. Companies like Advanced Medical, Best Doctors, 2nd MD, and Grand Rounds, provide access to world renowned doctors that provide an expert second opinion on the current diagnosis and treatment plans. Such services assure application of more uniform evidence based case standards independent of patient's geography thus controlling unwarranted variation due to local practices. The key challenge remains to get the right patients to use these services at the right time for employers and patients alike to get the most value from them.
Predictive analytics can be used to identify individuals who may be heading down the path to costly and ineffective treatment, and encourage them to seek a second medical opinion to determine if their treatment plan is the best option.
Have you ever used a second opinion service? Do you encourage your employees to do so? Do you use predictive analytics to identify the right individuals that can benefit from these services?