The majority (90%) of the nation’s $3.8 trillion in annual healthcare expenditures is for patients who struggle with chronic illness and mental health conditions.
The five most expensive conditions influencing 50% of healthcare costs are neurological, gastrointestinal, musculoskeletal, heart disease, and cancer.
Doctors who implement value-based care can save patients money through preventative health practices.
Being sick isn’t cheap. This is especially true of individuals with chronic illnesses, whose conditions take a considerable toll on health and economic costs in the US, as reported by the CDC.
To get a clearer picture of illnesses that drive up healthcare costs, UnitedHealthcare published a white paper by Health Action Council on the top five most costly conditions, outlined below. Doctors can combat rising costs associated with these conditions by providing value-based care through preventative health measures and integrated management.
Top 5 most expensive health conditions
Increasing healthcare affordability necessitates a thorough understanding of the most expensive conditions.
According to Health Action Council, these are the top five conditions driving up 50% of total health costs:
5) Neurological conditions. Amounting to $225 million paid by employers and $240k in claims, neurological claims often result from spinal cord injuries and seizure conditions. Females have a 28% higher prevalence of neurological issues than males. Claims are slightly higher for children under 12; for adults, they tend to rise with age.
Patients earning $75k–$200k annually are most likely to file claims for neurological conditions such as multiple sclerosis, migraine, carpal tunnel syndrome, Parkinson’s disease, or epilepsy.
4) Gastrointestinal (GI) conditions. These conditions cost employers $284 million, with $136k delegated to GI-related claims f. Females are 17% more likely to experience GI conditions, and higher claims for infants are often related to reflux or colic.
In the workplace, irritable bowel syndrome (IBS) is a common culprit, causing over 85% of affected employees to miss work on occasion due to their symptoms or fatigue. Those who miss work may experience anxiety over the detrimental effect on their productivity. Employees with celiac disease often find themselves excluded from morale-building work functions due to lack of access to safe foods.
Other typical GI diagnoses include colitis, Crohn’s disease, and pancreatitis. Immunosuppressive drugs are the biggest cost driver of GI issues, as they are usually expensive biologic specialty drugs, although lower-cost biosimilars now exist for some conditions.
3) Cardiovascular disease (CVD). CVD drives employers to pay $357 million, while claims amount to $169k. Males have a 6% higher prevalence of heart disease, and cardiovascular claims rise with age. Patients who make less than $75k per year have the most CVD claims; this is especially true in US southern states, where obesity and physical inactivity are contributors.
The main diagnoses include heart rhythm issues, stroke, heart attack, and clogged arteries. Treatments for abnormal heart rhythms are the primary cost drivers associated with heart disease.
2) Musculoskeletal (MSK) conditions. These conditions cost employers $477 million and $317k in claims. Females have a 22% higher prevalence than men. MSK claims are higher among kids between 13 and 17 years of age, most often due to sports injuries.
Joint wear and tear, torn rotator cuff, hip pain, lower back pain, and knee injuries are a few conditions under the MSK umbrella. Knee osteoarthritis is the primary cost driver of MSK claims.
1) Cancer. The No. 1 most expensive condition for employers is cancer, costing them $553 million and $103k in cancer claims. Females have a 52% higher prevalence than males, because of breast cancer, and older populations are at a higher cancer risk. Those earning a yearly income of less than $75k are more likely to have cancer at some point.
Chemotherapy is the largest cost driver in cancer claims.
Other expenses include diagnostic tests, outpatient procedures, hospital admissions, and radiation therapy.
Providing value-based care
One way physicians can help keep healthcare affordable for patients struggling with these conditions is by implementing value-based care.
According to an article published by the Cleveland Clinic, value-based care saves patients time and money through preventative health measures and management by one integrated team.
For example, a patient who quits smoking, exercises regularly, and improves their overall health through dietary and lifestyle changes is much less likely to need costly tests, treatments, and procedures down the road.
Value-based care also helps patients avoid further complications of an illness they may already have.
If you have a patient with diabetes, teaching them to manage their blood sugar and reach realistic exercise goals could keep their condition from worsening, minimizing long-term healthcare costs.
What this means for you
Approximately 50% of Health Action Council’s covered individuals had claims for at least one of these conditions: Cancer, musculoskeletal conditions, cardiovascular disease, gastrointestinal conditions, and neurological conditions. Together, these conditions contribute to about $1.9 billion of healthcare expenditures. Cutting healthcare costs requires health professionals to better understand and address these conditions, including their primary cost drivers. Doctors can help reduce healthcare costs for employers and patients by using a value-based care model.