Driving Down the Real Cost of Healthcare: Pediatric and Teen Medical Homes
At last, the presidential race has concluded and, as a nation, we can prepare to move forward. With President Obama’s election to a second term, implementation of the Accountable Care Act (ACA) moves full steam ahead. In light of the fiscal cliff – perpetuated by the expiration of the Bush tax cuts, the 2009 Economic Stimulus provisions, the payroll tax holiday and 67 other tax provisions – the question still remains, how do we make a significant impact on cost reduction in healthcare?
While much has been written about the spiraling cost of chronic care, I found it surprising to learn that spending on healthcare for commercially insured children under age 18 grew faster than spending for adults from 2007 to 2010. After examining more than three billion insurance claims from three major carriers, the Healthcare Cost Institute reported that consumer spending on pediatric and teen healthcare increased 12% to nearly $88 billion dollars from 2007-2010, while spending on adults increased at a slower rate of 8%. Even more intriguing, it seems that spending for children’s healthcare increased despite decreasing numbers of children covered and utilization of healthcare services, such as hospital stays and brand-name drugs.
If utilization is not driving this increase in healthcare cost, then what is? According to the report, a number of activities are contributing to this trend, including increased use of consults, procedures and testing facilities. Digging deeper into the data, the study also revealed that two groups are incurring the highest cost: infants, three years and younger and teenagers, aged 14-18. While the increasing expense associated with pre/peri/post-natal births and associated outcomes is comprehensible for the infant cohort, what makes les sense is the skyrocketing expense for prescription drugs for central nervous disorders, such as anti-depressants, anti-anxiety disorders and drugs used to treat ADD or ADHD in the teenage population.
By and large, families were spending the greatest amount on primary care visits, immunizations, and preventive medicines (40.3%), followed in short order by outpatient procedures (24%), inpatient procedures (22%) and prescription drugs (14%). Sufficed to say, this study did not include children participating in the Medicaid or CHIP programs, so it is difficult to discern if similar trends occurred in this population. As the author points out, regardless of payer, children with exponential healthcare costs grow into adults with unsustainable expense. Recognizing the benefit of medical homes for low risk pregnant women and children, it would be a fascinating case study to enroll willing participants currently attending a MindUp program that were committed to learning how to cook healthy food options using locally grown fruits and vegetables and engage in healthy exercise regimens. Last but not least, reaching this critical and vulnerable population will be key. Incorporating text messaging, voice, email, video and animation in efforts to successfully communicate important healthcare messages, similar to the program below, will ensure that mothers, infants and teens seek wellness and prevention, in efforts to reverse this frightening trend.