The high cost of unnecessary care

May 11, 2021
Lindsey Logan

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It’s important to health shares  to keep organizational costs low. One of the best ways to do so is to guide members to the right kind of care. With that, it's also crucial to help members avoid unnecessary care. It might be shocking, but over-treating patients is rather common in the U.S. healthcare system. Physicians and hospitals have incentives to complete as many surgeries or procedures as possible, even when they're not needed. Unnecessary scans, screenings, and tests cost the American healthcare system millions every year. In fact, studies have shown billions of dollars each year go to unnecessary procedures, surgeries, and imaging.

By the numbers. 

  • According to the National Academy of Medicine, about $765 billion goes to waste every year. That's one-fourth of all the money spent in the American healthcare system.  
  • Approximately 85 percent of lab tests to prep healthy patients for low-risk surgeries are not necessary. These tests waste about $86 million every year. 
  • Annual heart tests not needed for low-risk patients consumed $40 million.

What you can do to help members.

Health shares have an opportunity to take significant steps to simplify their members' health. Your organization can guide members to make smarter healthcare choices that result in lower costs.

One of your first and easiest options to help members is to educate them on how to get second opinions. Second opinions can help cut unnecessary procedures and treatments. Another option is to recommend doctors who endorse other options first. Lifestyle changes or physical therapy can often be used first to avoid unnecessary surgery. It’s also helpful to encourage patients to research anything they are prescribed to ensure it is beneficial to them.

The next hurdle to overcome is members' apprehension about researching complex healthcare information. As a health share, you can reduce this fear and confusion. A good option is to partner with a patient advocacy company that offers members healthcare navigation. This gives members a dedicated patient advocate who cares about them and their needs. More hands-on members can try easy-to-use technology to shop and compare thousands of healthcare services.

Final thoughts.

Sometimes surgery is the only solution to fix a problem. But, there are also several medical situations where surgery should be a last resort. "The power of the lab coat," can sway members to receive expensive, invasive care they don’t need. As a health cost sharing organization, you can provide your members with reliable resources and patient advocates to guide their healthcare. And the good news is that when members receive affordable, quality care it helps you too by keeping sharing costs low. With healthcare navigation solutions, you can reach your goals of keeping costs low while making sure members are happy and healthy.

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Download Your Guide to 2022's Healthcare Policy Changes

Discover the major changes happening that affect you, how to prepare, and even how to make the new rules work in your favor.

Download The Limited Benefit Plans’ Guide to Competing On More Than Price

Discover how to stand out based on unique offerings and high member satisfaction, and how to implement these strategies.

Download The Complete Guide to Implementing Price Transparency

Discover how to bring price transparency into your benefit offerings to increase member satisfaction, lower overall costs, stand out from competitors, and improve member retention.

Download Your Roadmap to Creating Engaged Healthcare Consumers

Discover the roadmap unique to your health plan type and start seeing higher member satisfaction, lower overall costs, and healthier members.

Download How to Leverage Ambulatory Surgical Centers for Lower Costs and Higher Satisfaction

Discover how TPAs, health cost sharing groups, and limited benefit medical plans can benefit from the use of ASCs.

Download the Patient Advocacy 2.0 White Paper

Discover what health plan members had to say about the value of patient advocacy in our survey.

Download the Complete Guide to Retaining Health Plan Members.

Learn the best strategies and tips for retaining your members while keeping costs low.

Download the Complete Guide to Growing Your Health Plan Membership

Learn the best strategies and tips for growing your members while keeping costs low.

Download the Complete Guide to Lowering Member Costs

Discover what health plan members had to say about the value of patient advocacy in our survey.

Download Healthcare Consumerism 101: A Playbook for Health Plans

Learn the best strategies and tips for retaining your members while keeping costs low.

Download Your Guide to the Transparency in Coverage Rule

Discover how the the new rule will affect TPAs and health plans and how you can start your journey to compliance.

Download Your Guide to Unique Benefit Offerings that Don't Break the Bank

Discover how to add value to your health offerings that delight clients and members but don’t cost a fortune.

Download the Complete Sedera Case Study

Discover what health plan members had to say about the value of patient advocacy in our survey.

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