Overview
Create a reply/response to Melissa and Linae. Reply 100 words for each
Melissa : Patients should definitely be responsible for containing and controlling their healthcare usage and costs. Every cent spent on healthcare means all members of that plan will eventually be paying for it. There are several ways to control healthcare costs on an individual level. Using preventative care, such as sticking with the recommended vaccine schedules, means not catching certain illnesses, or at least ensuring they’re less severe, and this means lower healthcare costs in most cases. Another way to control healthcare costs is by choosing a healthier lifestyle. This can be in the form of getting consistent, moderate exercise weekly, eating more fruits and vegetables and fewer processed foods and fatty meats, and eliminating bad habits, such as smoking and drinking alcohol. These healthy lifestyle changes usually result in lower cholesterol, lower blood pressure, and healthier body tissues, and can also stave off chronic illnesses such as heart disease and diabetes.
Insurance companies also have a responsibility to use technology to lower their risks, which also lowers costs. They can and should promote telehealth visits at low or no cost (and these visits are much more convenient for patients who have mobility issues), use AI prediction medicine, and fully cover basic screening tests, such as heart CTs, mammograms, colonoscopies, and so many more for those patients who may be high risk.
When the ACA made screening colonoscopies to no longer require cost sharing by the patient, studies found that colon cancer testing increased, which means more patients are receptive to colonoscopies as a preventative method (Xu et al., 2020). Identifying issues before they become major problems not only saves money in the long run, but it also improves patients’ lives. Plus, if patients don’t have to pay hundreds or thousands of dollars for these tests, they will be more likely to get them.
I also believe employers have an obligation to lower costs, too, by offering health incentives to employees. I work for UnitedHealth Group, and as an employee, we are given incentives each year to lower our insurance costs dramatically by completing biometric screenings, which can be done at home or at a lab. It’s super convenient, and if we hit target goals, we can earn up to $600 towards insurance costs for that year.
They also promote exercise, so we have an app called Rally that we can choose to track our workouts, walking, etc. to win coins and competitions which can also correlate to lower costs. I’m usually able to earn the maximum of $800 a year that’s applied to my health insurance, which means I only pay about $40 a month for a great health plan. So, yes, I do believe we all have an obligation to do what we can to decrease moral hazard and healthcare costs so that everyone has a chance to receive responsible, affordable healthcare.
In addition, providers and healthcare organizations also share responsibility for healthcare costs. In the audits I’ve performed through my job, I’ve found waste and errors due to providers not documenting correctly, or ordering tests that have no justification. However, this is a topic probably best reserved for another day, but fraud, waste, abuse and error are close to my heart when it comes to healthcare due to the staggering cost to the CMS programs, especially Medicare. In short, we all have an obligation to ensure future generations are able to receive the healthcare they need without excessive financial burden.
Xu, M. R., Kelly, A. M. B., Kushi, L. H., Reed, M. E., Koh, H. K., & Spiegelman, D. (2020). Impact of the Affordable Care Act on Colorectal Cancer Outcomes: A Systematic Review. American Journal of Preventive Medicine, 58(4), 596–603. https://doi.org/10.1016/j.amepre.2019.11.018
Linae : Based on this Ted Talk, this is how I see the roles and duties of different groups (patients, insurers, providers, and technology) in keeping healthcare expenses down and making it possible to monitor patients from a distance: 1. Patients They are responsible for taking care of their own health by living a healthy lifestyle, following the treatments their doctor gives them, and using monitoring instruments if they are available. Sesto says that patients are becoming more active partners in their care, not just those who get it. Monitoring usage: Patients can assist keep costs down by adopting telehealth or remote monitoring when it's suitable. Costs go up when patients don't know what's going on or don't become involved. Sharing data and being open: Patients should be willing to share health data (wearables, remote sensors) so that early warning indications can be acted on. 2. Payers and Insurance Companies Give people access to portable technologies: Insurance companies should buy tools (wearables, remote monitoring platforms, applications) that let patients be monitored at home or in the community. A good example of these that we use at my job is holter monitors which keeps track of cardiac events. This will keep them from having to go to the hospital, which is quite expensive compared to wearing those devices. The Ted Talk makes a big deal about how technology moves the focus of monitoring away from the hospital. Incentives for preventive and remote care: Instead of only paying for hospital stays, payers can build up benefits to encourage remote monitoring, early intervention, and lower-cost settings. Design advantages that help keep costs down: Insurers should invest in predictive analytics, remote monitoring, and value-based care models to help cut down on unneeded services like extra tests and hospital stays that could have been avoided through preventative or early detection metrics. 3. Healthcare Providers Accept and use technology: Doctors, nurses, and other care team members need to be able to read data from remote sensors, plan virtual visits, and change processes so that care can be given outside of the hospital. Sesto's presentation refers to a change from treating problems as they come up to keeping an eye on them and stepping in sooner. Educate patients: Providers must teach patients how to use monitoring tools, telehealth platforms, and what to do when they get early signals. Work together across settings: Providers must work closely with payers and technology vendors when using remote monitoring to make sure that care is continuous, that problems are dealt with quickly, and that interventions are cost-effective. 4. Providers of technology and platforms Make monitoring platforms easy to use and accessible: The "what if" idea is that if everyone could afford remote monitoring technologies, many people might not have had to go to the hospital. Sesto said that technology is making new areas of care possible. Make sure that data can be shared and is safe. For remote monitoring to perform well and be cost-effective, platforms need to work with EHRs, telehealth, and care-team workflows and keep patient data safe. Allow for analytics and predictive insights: Platforms should not only support remote devices, but also predictive warnings (for example, spotting early indicators of decline), which would allow for earlier and less expensive interventions.
Responsibilities that are shared and work together Cost containment isn't only about slashing services. It's also about moving treatment from expensive places like the ER and hospital to less expensive, proactive places like home, the community, and telemedicine. When remote monitoring works, everyone wins. Patients get better health and spend less time in the hospital; payers save money; providers give better care; and technology vendors find new markets. A culture of involvement and accountability means that patients need to feel responsible for their own health, payers need to pay for or reward remote treatment, clinicians need to change their workflows, and technology needs to make monitoring easy. What Could Happen If We Take on These Duties? Lower hospital readmissions and fewer unnecessary admissions mean lower expenses for the system. Earlier detection of worsening chronic illnesses leads to better outcomes and less severe treatment. Better use of resources: Only use expensive emergency services when absolutely necessary. More equal access is possible: If insurers and tech companies work together, patients in rural or underserved areas can get monitoring that they couldn't get before.
Sesto, N. (2022, May 17). Changing the role of patients in 21st-century medicine [Video]. YouTube. https://www.youtube.com/watch?v=axZ1pbb6Zuw