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The 5 Best Ways to Waste Money in Healthcare

Updated: Jun 10



Yikes! The most careful analysis ever, done for Washington state, reveals that 38% of all heatlhcare spending is wasted. And that estimate is probably on the low side because it excludes things the actuaries doing that study don't even know about.

Some of this waste can be avoided, by teaching employees to Just Say No to useless healthcare. Not with a noble approach like "When you spend [our] money inappropriately, it drives up everyone's healthcare cost." But rather by pointing out the potential harms to them personally. We teach: "Just because it's healthcare doesn't mean it's good for you." Here are 5 of Quizzify's Greatest Hits of avoidable healthcare waste.

 

Weight Loss Drugs


By now it is well-known that most people who start these drugs either give up early or gain the weight back later. 1 in 12 adults have tried them, largely at their employer's expense. If you have access to our Weight Loss Drug Economics Calculator, you'll see that coverage of these drugs likely doubles your rate of increase in total healthcare spend.


Coverage involves PBMs, and the PBMs claim they are doing prior authorization, but their incesntives are likely misaligned with yours to begin with. And people who want them can simply binge their way to the BMI threshold, and/or just ask their doctor, who is probably being graded on satisfaction and doesn't like to say no. (You'll see the "Don't Say No" theme below in the other Drivers as well.)


The answer is quite simple: since most people are going to drop out eventually anyway, discourage them from starting. That is precisely what Quizzify's Before Your Journey quiz does. It allows employees to learn for themselves what the downsides of thsse drugs are. There is a reason we call it the "Curb Their Enthusiasm" quiz.


Even if your PBM contract prohibits you from doing your own prior authorization (as many such contracts do), they can't prohibit your from educating your employees.


Quite the opposite: it is your fiduciary obligation to educate your employees on these drugs, as this posting in the Wellness Law blog explains.


 

Back Surgery


Or for that matter, back MRIs, cortisone shots or even Advil. All are dramatically overused.


We teach our mantra: "80% of back pain goes away on its own, but 80% of people with back pain are convinced at some point they are in the other 20%."


Other specific observations we teach:

  • 99% of surgeons polled at a conference agreed they would never get a spinal fusion.

  • Only 37% of spinal fusion patients are happy with their outcomes 15 years later.

  • A woman sent to 10 MRI centers received 49 findings. No two centers agreed and none actually got the right answer. (Nothing was wrong with her.)

  • Cortisone shots provide only temporary relief, and leave many people off worse than before.

  • In quantities large enough to reduce inflammation taken regularly, Advil may slow healing and cause kidney complications.

  • Bedrest is a bad idea in most cases.

  • Situps make most back pain worse.


You can use a vendor, at a nontrivial expense, and they'll do a good job, but a lot (probably not all) their patients would have improved anyway.


 

Scans


Americans get twice as many scans as Europeans, with worse outcomes.


Doctors don't need any encouragement to order them, since they do that just fine on their own. We focus on subliminally discouraging employees from demanding even more, because doctors often prefer to simply order these tests than explain why they aren't needed. Our health education lessons include:

  1. Alerting people to the amount of radiation in these scans, which doctor rarely mention.

  2. Setting an expectation that the scan may "find" something it wasn't even looking for. This happens so often that there is even a name for these usually false-positive findings: incidentalomas.

  3. Recommending that people ask if IV-administered dye is involved. That adds a risk of kidney allergy.


Patients also demand absurd numbers of MRIs, the difference being that they are harmless if no dye is involved. So they are harder for us to caution against. We do bring employees' attention to two things they likely don't know, that might discourage them from demanding an inappropriate one:

  1. The dye used in about a third of MRIs does get lodged in your brain. Harms from that are extremely unlikely. Nonetheless, some people pass on demanding MRIs once they learn this.

  2. These are not a gold standard. One study involved sending the same woman to 10 imaging centers. The total number of findings? 49. No two centers matched, and zero got the right answer, which was that nothing was wrong with her.


Another thing we teach? The four most wasteful words in all of diagnostic medicine are when a doctor starts a sentence: "Just to be safe..."


The seven words we teach saying in return: "How might this change the treatment plan?"

 

Checkups


There is a shortage of primary care physicians in your area.  How do we know that?  We’re a trivia company. We know everything.  (Also this is true everywhere in the US, so there’s that…)


On the off-chance that your organization is comprised of first-responders, skip this section. First responders don't get enough preventive care, probably the only job category in which that can be said.


As for the rest of us, consider three things in combination:

  1. There is a shortage of primary care physicians.

  2. Many people don’t need annual checkups. See here and here and here and here.

  3. Employees often earn incentive "points" for getting checkups they don’t need, while employees who do need primary care may not be able to access it – and up in the ER, all due to the shortage.


Fortunately, you can help to solve this problem and save money at the same time by guiding employees get checkups at medically appropriate intervals.


There are two ways to match checkup frequency with employee need:


  • Allow employees to earn their incentive by getting a note from their doctor saying they don’t need a checkup this year. After all, who better to judge whether someone needs a checkup than their doctor, right?  A doctor would only agree to this if there was a good doctor-patient relationship – a great incentive for employees to develop one.

  • Greenlight Quizzify’s preventive care quiz, which will help employees make informed decisions about all preventive care.  Generally – and there are exceptions –we recommend two checkups in your 20s, three in your 30s, four in your 40s, five in your fifties and then annually after that. 

  

You might wonder why, if everyone should not get one every year, the Affordable Care Act (ACA) makes them free every year to everyone? Answer: in 2010, when the ACA was passed, it was thought they might have value for everyone. Those links above all postdate 2010.

 

Cavities


We've done this one to death but still work repeating: 2/3 of cavities don't need to be filled. There is a miracle solution that is simply painted onto the cavity and stops it, same as a filling only totally pain-free, cheaper and (in most cases) better, because no extra enamel needs to be drilled out to create the concave hole to fill. Or maybe it's convex. I get those mixed up, but to keep the filling from popping out, the middle of the drilled area must have a creater circumference than the surface.



Filling cavities is by far not just the #1 clinical procedure in the US. By an even greater margin (over scans) it is the #1 most overused clinical procedure in the US.


Because dental insurance is so "skinny" and costs so little, it may not seem like a big deal to you. But it is to your employees, who have to struggle not just with their share of the expense, but also with their kids' stress (see examples here). Not to mention the time away from work.


 

Quizzify to the rescue


Quizzify can address all of these cases of useless healthcare driving up costs. Inexpensively, with fees tied to outcomes. We can be up-and-running in days, with results showing soon thereafter. Just contact us for more information.





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