Talk: West Health Launches AJPM Supplement on Lowering the Cost of Health Care

Join the discussion on the American Journal of Preventive Medicine Supplement focused on health care cost crisis

The West Health Institute and the American Journal of Preventive Medicine have collaborated on an extensive peer reviewed publication providing insights on how key stakeholders can help avert the crisis of expanding costs in health care.

Titled “Addressing the Cost Crisis in Health Care: Stakeholder Roles and Responsibilities,” this Supplement to the American Journal of Preventive Medicine brings together thought-leaders throughout the health care ecosystem to discuss the cost crisis and some potential solutions being implemented today, from payer to patient, physician to policy maker and private industry to entrepreneurs.

We need you to join the conversation about the cost of health care as well. Each week, West Health will feature a new discussion on each of these articles. Follow us @westhealth on Twitter for updates, or use the links below for the full text of each article and to our LinkedIn discussion group on Lowering the Cost of Health Care below. You can also send your comments about the Supplement or any of its articles to ajpm(at)

Join the group and join the conversation.


The Stakeholder Imperative

On a national level, U.S. healthcare costs of more than $2.7 trillion/year consume nearly 18% of our gross domestic product (GDP) and challenge our economic viability, international competitiveness, and even our national security. Yet they continue to grow. The average employer spends nearly $12,000 per employee on healthcare coverage, an economic burden the employer struggles to pass on to customers. In addition, the average family spends $1115 on insurance premiums and $235 on out-of-pocket healthcare expenses each month. A recent projection estimates that, by 2030, the combined cost of family insurance premiums and out-of-pocket expenses will exceed average family income. Clearly, change in both healthcare delivery and payment systems are imminent and inevitable, and every stakeholder has a separate but vital role to play in this coming transformation. Read the full text of this synopsis.

A Role for Physicians: An Observation on Cost Containment

Neel Shah of Costs of Care and the Harvard Medical School, a physician who passionately believes that physicians are as much a part of the problem as they can be in the solution, says that catalyzing the national mandate for “accountable care,” an emerging market for price transparency, and the disruptive promise of mobile and other information technologies will make bedside cost–consideration an inevitable part of clinical practice. Notably, the American Board of Internal Medicine’s Physician Charter calls on physicians to scrupulously avoid “superfluous tests and procedures” in an effort to provide care that is “based on the wide and cost-effective management of limited clinical resources.” He is hopeful that under evolving reimbursement systems, there will be a positive business case for providers to not only make the correct diagnoses but also to deliver value.

Additionally, he believes that in the near future, price-transparency tools are likely to become more accurate, comprehensive and widely used. In concluding that any solution has to involve physicians he is clear: "Because physicians decide which tests and treatments will go on the bill, no amount of regulating, reorganizing or otherwise reforming the health care system will be adequate unless physicians are invested in fıxing the problem." Reiterating, "Some believe that the public trust in physicians may make them the ‘only plausible catalyst to accelerate diffusion of cost-effective care."

What do you think about Neel Shah's conclusions? Join our LinkedIn group on lowering the cost of health care to comment there.

A Role for Entrepreneurs: An Observation on Lowering Healthcare Costs via Technology Innovation

This week, let’s take a look at an entrepreneurial outlook on lowering the cost of health care, from Josh Makower and Scott Gottleib of the American Enterprise Institute and Stanford University, respectively. These authors were quick to point out that the FDA was instructed, in the 1997 Food and Drug Administration Modernization Act (FDAMA), to issue guidance on how manufacturers should make economic claims about their products. But the FDA still has not delivered such guidance, the authors note. The FDA also holds a conservative view on comparative claims among products, generally requiring superiority studies. Although there are arguments that the FDA should not use the cost effectiveness of treatments as a criterion in weighing clearances and approvals, the authors say there should still be discussion on fınding a way for sponsors to pursue those claims on their own. Such studies can play a valuable role toward competition in the marketplace, according to the authors.

Should FDA issue guidance on economic claims of their products? Read the full text of the article, and join the conversation on health care costs at our LinkedIn group to discuss.

We’ll be back with the next article from the AJPM Supplement on lowering the cost of health care in 2013. See you next year.

A Role for Payers: Remarks on the Use of Data and Analytics in Support of Preventive Care

Dr. Reed V. Tuckson, MD, FACP, the executive vice president and chief of medical affairs at UnitedHealth Group contributed an article to the AJPM Supplement providing the point of view of a payer. He was clear that big data married to careful analytics was a path to refining treatments around chronic disease, the big problem. "At the same time, preventive forecasting is being done on the effects that specifıc interventions can have on subpopulations at risk of developing chronic illness. For example, Optum, UnitedHealth Group’s health services company, uses its Natural History of Disease tool, which draws on historical, de-identifıed medical data from approximately 70 million people to pinpoint precursors for chronic conditions such as diabetes. Detection of these precursors has enabled early intervention. Additionally, because the database includes information from many other companies, comparative analysis can identify best practices for more successful intervention." Integration of disparate types of data is thought to add great insight – pointing to the need to "integrate health risk and medical condition data with socioeconomic, demographic and individual preference information more commonly used in other consumer-centric businesses. The system employs hundreds of algorithms to examine data sets to more precisely identify who needs to be reached for prevention engagement, with what specifıc messages and how best to reach them."

What can and should payers do with big data and patient forecasting to help lower the cost of health care?

Full text | Join the conversation in our Lowering the Cost of Health Care group

A Role for Research: An Observation on Preventative Services for Women▼

In Peter Neumann's piece with Natalia Olchanski and Joshua Cohen of Tufts Medical Center, you will see the authors discuss how there are huge gaps in health economics literature for preventive measures — we often believe (without sufficient data support) that prevention is cost-effective — in many cases, we have too little data to support these beliefs and, in some, are probably mistaken. The authors are quick to point out that policy recommendations to use cost-effective/cost-saving services (preventive or otherwise) will not be sufficient – one must also assure availability and that individual stakeholder incentives align for adoption. And finally, the authors write, there is a need to constantly monitor for both adoption and persistent evidence of value in the more diverse populations of actual use vs. the narrow populations in clinical trials.

How do you think health economics research and literature should address preventive measures?

Read the full text of the article | Join the conversation in our Lowering the Cost of Health Care group