Billions Spent on Asthma Treatment, but How Much May Be Avoidable?

Billions Spent on Asthma Treatment, but How Much May Be Avoidable?

NEWTOWN, CT – October 11, 2016 – A new analysis of health care data indicates that, among patients with Medicaid or commercial insurance, about $38.3 billion annually is spent to treat potentially avoidable complications associated with asthma. Identifying the causes and preventing the development of these complications are powerful opportunities to improve care and lower costs in the health care system, especially considering the prevalence of asthma in the United States. According to recent data, about 7 percent, or 24 million Americans have asthma, with numbers growing over the last decade.

Researchers at the Health Care Incentives Improvement Institute (HCI3) evaluated administrative claims data for more than 800,00 individuals, ages 2 to 64, treated for asthma and covered by commercial insurance or Medicaid. The analysts processed the claims data through PROMETHEUS Analytics©, a software solution that separates costs of “typical” care from costs associated with potentially avoidable complications. These complications are events that negatively affect patients, and that may be controllable by the clinicians delivering care to the patients. Among asthma patients, potentially avoidable complications can range from hypotension to respiratory failure. And the HCI3 analysis found that such complications are costly and common among Medicaid and private insurance members.

“Americans are always hearing how difficult it is to contain health care costs,” says François de Brantes, coauthor of the study and executive director of HCI3. “But providers and payers can pinpoint expensive complications, and take steps to minimize or eliminate them. It’s a great place to start.”

Data showed the majority of asthma patients experience at least one potentially avoidable complication, costing an average of $579 per year for patients with private insurance and $1,016 for those with Medicaid. Such costs represent almost 32 percent of asthma care costs among the commercially insured population and 38 percent under Medicaid. Extrapolating these data to the national population of adults with asthma, the researchers calculated about $13.9 billion dollars annually in care for potentially avoidable complications suffered by people with private insurance, and about $24.4 billion for those with Medicaid.

Measuring potentially avoidable care costs is just one step toward improving quality and affordability of care, says de Brantes, but it’s a crucial one. “Without the spotlight on problem areas, there’s no progress. Data insights make it possible to alter payment models so they reward excellence, or to modify some clinical practices.”

The report is Identifying Sources of Variation in Asthma Episodes of Care with PROMETHEUS Analytics. It is available online at http://bit.ly/asthma-brief, and includes analysis of additional forms of low-value care: potentially avoidable services and gaps in asthma care.