Closing Healthcare’s Greatest Gap | Part 2: The High Cost of Fragmentation
Welcome to Closing Healthcare’s Greatest Gap. In this second in a series of five blogs, we’ll examine the economic costs caused by the inefficiencies of America’s fragmented healthcare system.
A $3 Trillion Issue
Consider this fact. Nearly $3 trillion—an astounding 90% of total healthcare expenditures in the United States— is spent each year to treat patients with chronic and mental health conditions. [1]
Cost-effective management of these two types of medical conditions requires an ongoing continuum of care, one that the current healthcare system is unable to provide. [2] But such a continuum does not exist today. That’s because, as we saw in our previous blog, healthcare is divided into two systems, “Getting Care” and Staying Healthy,” that operate, for the most part, in disconnected silos. Once patients are “officially” discharged from the healthcare system (“Getting Care”), they are mostly left to their own devices to manage their health. It is largely their responsibility to provide the impetus, motivation and encouragement that ensures their follow-up care is effective.
This is especially detrimental to patients with chronic and mental health conditions. Without an ongoing continuum of proactive care, these patients lack the support and resources they need to follow their treatment plan and stay healthy. A lack of communication results in patients receiving little (if any) ongoing education and encouragement to engage. Questions go unanswered. Follow-up visits and support are sporadic. Few incentives are provided to motivate patients to stick with their treatment plan and engage in healthy activities that will reduce the likelihood of a recurrence.
The High Cost of Fragmentation
The economic consequences caused by this fragmented healthcare system are severe and significant. Here are just three examples.
Medication Non-Adherence
Scenario: Patients don’t receive ongoing encouragement and support to stick with their treatment plan. Because of this lack of follow-up care, patients often forget the clinical importance of taking their medication.
Result: 25% of hospitalizations each year are related to medication non-adherence.2 Up to 30% of new prescriptions, including those for diabetes and high blood pressure, go unfilled. [3]
Care Navigation
Scenario: Patients become confused and frustrated when they try to navigate the complexities of the American healthcare system.
Result: Up to $45B in unnecessary healthcare spending stems from inadequate care coordination and poor care transitions. [4]
Unnecessary ER Utilization
Scenario: Patients don’t know how to properly manage a condition and/or can’t determine what level of care they need when an urgent medical need occurs or complications arise.
Result: Patients default to the most costly options—the ER or Urgent Care— generating $47 billion annually in unnecessary costs. [5]
In our next blog, we’ll take a closer look at how point-solution proliferation is fragmenting the consumer well-being experience.
At Pager, we believe addressing the high costs and multiple inefficiencies that define American healthcare today requires replacing a fragmented care delivery system with a seamless and connected consumer experience on a single platform Discover how Pager can help your health plan lower costs and improve care by ending healthcare fragmentation. For the full story, click here: Closing Healthcare’s Greatest Gap: Replacing Today’s Fragmented Healthcare System with a Single-Source, Connected Consumer Experience.
Or contact us today for a free demo.
[1 ] Centers for Disease Control and Prevention. (2023, March 23). Health and economic costs of chronic diseases. Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/about/costs/index.html
[2] Jennifer Kim, P. (2018, January 19). Medication adherence: The elephant in the room. U.S. Pharmacist – The Leading Journal in Pharmacy. https://shar.es/afV3H9
[3] Brody, J. E. (2017, April 17). The cost of not taking your medicine. The New York Times.
[4] Transitions of care. NCQA. (2023, January 23). https://www.ncqa.org/hedis/measures/transitions-of-care/ https://www.nytimes.com/2017/04/17/well/the-cost-of-not-taking-your-medicine.html
[5] Paavola, A. (n.d.). Unnecessary ER visits cost $47B a year, report finds. Becker’s Hospital Review.
