Blog Post

Blog 10, Part II: Top Five Most Expensive Health Problems

Continuing our Top Five series with Veritas Healthcare Management (VHM) Chief Medical Officer Ernie Vesta, MD, today we review the most expensive health conditions identified by Ernie and his team in working with large group health benefit plans. Our goals, as we shared previously, are to help health benefit plan leaders consider their own plans and programs and also understand how VHM works to improve health while  lowering healthcare costs.

A few reminders:  This list may surprise you. Each encounter we have with a participant involves more than the presenting medical conditions and a diagnosis. After all, individuals are more than data points and labels that can be captured on a medical claim. Instead, they are complex human beings, and that makes each case more challenging—and progress more rewarding.

Keep in mind that VHM does not replace the plan participants’ physicians or other healthcare providers.  Veritas’ Chief Medical Officer and nurses work with the plan participants and their providers to produce improved health, lower healthcare costs and better quality of life.

1)  By far, end-stage congestive heart failure and end-stage renal disease/renal failure are the most costly conditions affecting health benefit plan participants. These are the cases often leading to organ transplantation.  Over their course of illness, participants are in and out of hospitalization, on dialysis (permanent or intermittent), and typically incurring huge medical and medication costs. Further, these enduring conditions take a toll on the emotional state of the individual, which further impacts physical health.

2)  The transplants themselves. We wrote in our Blog post, Renal Failure:  Avoiding the Point of No Return is Key, the cost of a kidney transplant can run roughly $250,000, plus an additional $10,000 – $15,000 per year in immunosuppressant drugs to support the transplant, according to data reviewed by Veritas Healthcare Management. Transplanted kidneys are expected to be effective only about 10 years.  According to Milliman in 2019, the average cost of heart transplant including inpatient stay was roughly $900,000 plus thousands of dollars monthly for the cost of immunosuppressive medications for the life of the transplanted organ.

3)  Mismatched care. This means participants have the wrong specialist for their medical problem or they have too many specialists involved in their care. Either way, the care they receive ends up not being the most effective or efficient. And that makes it more expensive.

4)  The presence of two or three medical conditions at the same time, out of control, interacting with each other. An example: diabetes and respiratory disease such as COPD.  It is common to treat exacerbation of COPD with steroids, but that makes it difficult for diabetics to manage blood sugar. In these cases, VHM finds it critically important to work with the participant to manage the level of prednisone they take. It involves an almost constant vigil, monitoring and responding to the impact on the body.

5)  Individuals not caring for themselves. Often, individuals will blame their former physicians for not effectively addressing something they need to address themselves through better diet, exercise, availing themselves of preventive care and practicing good hygiene, such as covering their months when they cough and washing their hands. These individuals typically will doctor shop, further increasing costs while failing to address the source of the problem.

Again, for each of these problems, personalized coaching and assistance from a skilled professional can help the participant better manage their conditions, address their questions and navigate the healthcare system at every stage of the journey. VHM helps break down the complexities of the situation into smaller considerations and differences, which are more manageable, particularly in large cases involving multiple specialists.

Next in the series:  Top Five Responses to Participants with Health Concerns.

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