Health care costs in the world are rising as people get older and there’s more demand for health services. And consumers, employers and brokers are bearing the brunt of this rise. Aetna International believes health insurers and providers need to adopt value-based care – a model where hospitals and physicians are paid based on patient outcomes – to buck the trend and contain costs.
Aetna International described its initiatives and efforts to prevent rising health costs – early intervention, care management, innovations and proactive member and provider engagement – in a December white paper called, “Bending the curve: Addressing rising costs in health care.” The United States spent $3.2 trillion on health expenditures in 2015, with spending projected to increase by 5.6 percent a year through 2025, according to the Centers for Medicare & Medicaid Services.
U.S. health spending estimated to increase by 5.6 percent a year through 2025
“Our in-depth analysis has highlighted there is a significant need to act now if we are to mitigate the rising costs in global health care. We are committed to prevention and intervention in all our undertakings, from health and wellness initiatives to our cost management service and strategies,” said Kelvin Schlief, senior director of medical economics for Aetna International. “Our expertise can be applied across all economies. In developing economies, we are able to help lay strong foundations if a health care system is not in place. We can also move the needle for governments in large economies by helping them establish the logistics for an efficient system.
“Through value-based initiatives, we are committed to prevention and intervention in all our undertakings, from health and wellness initiatives to our cost management service and strategies. We urge other global health insurers, providers and systems to embrace new technologies and services that support prevention and early intervention as a means to combating medical inflation.”
Unit cost – the prices charged for a service – and utilization – how often the service is used – are two main factors behind rising costs. The white paper notes an Institute of Medicine finding that 30 percent of health care services provided in the U.S. are unnecessary, wasteful or have no benefit for treatment.
Aetna International believes health care systems need to focus on holistic care and wellness, rather than providing episodic, reactive care and being demand-driven. Focusing on condition management instead of cost containment, Aetna International is using patient-centered approaches to address the rising health care cost and clinical inefficiency. For example, vHealth, Aetna International’s virtual care service, reduced the need for a physical consultation by 70 percent and a 35 percent drop in cost of outpatient care across a sample size of 10,000 consult since its launch in November 2016.
“Through value-based initiatives, we are committed to prevention and intervention in all our undertakings, from health and wellness initiatives to our cost management service and strategies.”
The company also uses advanced data analytics to identify and proactively manage members, who are at risk or have pre-existing chronic conditions. Aetna International also works with members to help them understand how their behaviors can influence their health and well-being, as well as empower them to take charge of their own health.
Multiple initiatives, such as preauthorization, case management and fraud, waste and abuse processes, are also in effect during the various stages of a member’s journey through the health care system. These initiatives ensure the member receives the right care at the right place for the right cost.
“The onus cannot just be on the individual to make the change,” the white paper states. “It is incumbent on the whole health care system – governments, payers, pharmaceutical companies, insurers, physicians and other health care providers – to collaborate, provide guidance and promote overall health and wellbeing.”