Health care costs: Tackling the big issues

There are four major disease categories that are driving 455 billion dollars of spend in this country a year, cardiovascular disease, musculoskeletal disease, cancer, and renal disease. They are being driven by pharmaceutical costs. Prevalence is going up, comorbidities are going up, diversity in practice patterns are going up. These are all continuing to drive an increase in spend trend. Cancer incidence is going up dramatically. The spend is predicted to go up by 45 billion dollars. Survivorship is expected to go up by 70 percent. Kidney disease is important because it affects 1 in 7 Americans and the incidence is growing rapidly. It is poised to be a top 10 cost driver for health care in this country in the very near future. Problem is, most people don't even know they have it. Complex conditions by their very nature are clinically complex, whether it's a complex cancer, congenital heart disease, spinal surgery, organ transplantation. They require teams of physicians. They frequently require multiple sites of services. They also tend to require sophisticated diagnostics and therapeutics, they require professionally coordinated care. And by their very nature they're expensive. Employers have been bearing the costs of these complex conditions for years. Health plans have similar issues as employers. Optum believes a comprehensive benefit management plan needs to be in place to address these complex conditions and the high cost trends that we have been seeing. You really need a coordinated benefit management plan that includes utilization management, care management, Centers of Excellence Network, and focus claims review. I kind of look at that as a four-legged stool. The whole package gives you the best chance of quality care for the patient, a quality experience for the patient, and reduction in overall cost for the employer-payer, which is really the triple aim that we are striving for.