Importance of Prevention Strategies to Lower Healthcare Cost
To decrease the burden on healthcare costs, at MC-Rx we strive to create awareness by educating our community regarding the importance of prevention.
Chronic diseases contribute significantly to health and economic costs in the United States. The leading chronic diseases, heart disease, stroke, cancer, and diabetes, account for $4.1 trillion in annual healthcare expenditures (1). Approximately one third of the deaths in the U.S. are caused by heart disease or stroke, which adds approximately $216 billion annually in healthcare system costs, and $147 billion (2) in job productivity losses. In 2017, diabetes diagnoses cost an estimated $327 billion (2). In addition, almost 600,000 people die from cancer each year, which is expected to add $240 billion to healthcare system expenses by 2030. To decrease the burden on healthcare costs, at MC-Rx we strive to create awareness by educating our community regarding the importance of prevention. Prevention is the effort to improve health, such as screening, health education, adherence to therapy, and adopting an overall healthy lifestyle. There are three different types of prevention (8):
Prevention can be accomplished individually, however, managed care organizations, health plans and employers can contribute by establishing strategies to help the insured adhere to prevention and treatment regimens to manage their health conditions. For the insured, this may represent a better quality of life, better health, and improved work performance.
One strategy that may help the insured optimize their treatment and help lower healthcare costs is a Diabetes Prevention Program (DPP). These programs have proven to reduce risk of diabetes, especially in people with pre-diabetes, via management of lifestyle changes (4). A DPP is a lifestyle management program proven to reduce the risk of diabetes among people with pre-diabetes through improved eating patterns, physical activity, and weight loss. For example, DPP has shown to cost effectively reduce diabetes by 58% and demonstrate healthcare savings of more than $3,000 in 3 years (4). DPP participants have lost an average weight of 4.3%, and program participation is associated with preventing other health conditions such as obesity, hypertension, and dyslipidemia. Another tool in the arsenal of prevention includes wellness programs. A wellness program is a social/lifestyle program intended to improve and promote health and fitness, usually offered through the workplace or through insurance plans directly to their enrollees (10). This has many benefits – for example, more productivity, increased employee morale, reduced absenteeism, and improved recruitment and retention of employees.
For primary prevention strategies, MC-Rx promotes access and appropriate utilization of immunizations, such as influenza, Covid-19, and pneumonia vaccines. Every year the U.S. spends approximately $27 billion treating diseases that could have been prevented by vaccinations (3). For every $1 spent on childhood vaccinations, there is a cost avoidance of $10.90 (3). According to the CDC, by 2021, 2.9 million medical visits, 65,000 hospitalizations, and 3,900 deaths were prevented by influenza vaccination6. Most recently, Covid-19 vaccines have prevented 18.5 million hospitalizations, and 3.2 million deaths in the United States (9). As for secondary prevention, MC-Rx supports screening, early detection, and management of diseases via educational platforms and health fairs. In addition, MC-Rx provides educational material aimed at patients, providers, health plans, employers, and other insurers to promote health literacy and commitment to a healthy lifestyle. You may visit the company webpage and view our comprehensive educational program including videos and blogs on the latest health topics (https://www.mc-rx.com/).
Finally, for tertiary prevention, MC-Rx ensures appropriate and timely access to important cost-effective, first-line, preventative medications such as statins, to prevent kidney disease in patients with diabetes. We also promote the integration of disease management programs into the pharmacy benefit. These programs exist for a variety of health conditions, including diabetes, hypertension, and obesity. To increase access and convenience, disease management programs can be available through digital platforms. For example, digital therapeutics are innovative applications aimed to treat or alleviate a disease, disorder, condition, or injury, by generating and delivering a medical intervention. It may benefit payers by reducing the overall cost of care by enhancing and optimizing current medical treatments, improving provider communication efficiency, and support value and outcome-based care initiatives (5). Data from digital wellness programs have shown a 9.3% reduction in healthcare utilization, 23.5% reduction in hospitalizations, and $5,077 reduction in cost for cardio metabolic conditions like diabetes (5).
At MC-Rx, we are committed to providing innovative care solutions that support patient access to treatment. One example of our commitment to provide access to affordable, cost-effective care was the early onset adoption of our Biosimilar/Biologic Program. Based on MC-Rx drug utilization data, after one year of implementing this program, the annual savings for our client was approximately 25% and beneficiaries experienced approximately 40% lower out-of-pocket costs.
In conclusion, prevention efforts at the primary, secondary, and tertiary levels help reduce development of chronic conditions and prevent complications of existing medical conditions. At MC-Rx, we challenge ourselves to constantly look for strategic innovation, but keep our focus on the basic clinical principles of patient care, service, and individualized attention. The MC-Rx clinical team of experts is composed of pharmacy doctors that partner with clients to develop drug formularies and clinical programs which focus on delivering access to evidence-based, cost-effective care.
References:
Health and Economic Benefits of Chronic Diseases. (2023). Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/about/costs/index.htm.
Health and Economic Benefits of Chronic Disease Interventions. (2023). Center for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/programs-impact/pop/index.htm
Vaccines Are Cost Saving. (2020). Vaccinate Your Family. https://vaccinateyourfamily.org/why-vaccinate/vaccine-benefits/costs-of-disease-outbreaks/
Cost Savings and Reduced Health Care Utilization Associated with Participation in a Digital Diabetes Prevention Program in an Adult Workforce Population. (2020). Journal of health economics and outcomes research. https://doi.org/10.36469/jheor.2020.14529
Value of DTx. Digital Therapeutic Alliance. https://dtxalliance.org/
Estimated influenza illnesses, medical visits, hospitalizations, and deaths prevented by vaccination in the United States – 2022-2023 influenza season. (2023). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/about/burden-averted/2022-2023.htm
Prevention. Centers for Disease Control and Prevention. https://www.cdc.gov/pictureofamerica/pdfs/picture_of_america_prevention.pdf
Use of updated COVID-19 vaccines 2023–2024 formula for persons aged ≥6 months: Recommendations of the Advisory Committee on Immunization Practices. (2023). Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/72/wr/mm7242e1.htm#:~:text=Introduction,the%20United%20States%20(1)
Wellness Program. Healthcare.gov. https://www.healthcare.gov/glossary/wellness-programs/
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