How Digital Care Can Help Prevent Costly, Invasive and Unnecessary Procedures

This article first appeared on BenefitsPRO.com.


Nobody enjoys walking through the glaring white lights of a hospital while their loved one is being rolled into the operating room or cardiac catheterization lab. For the patient and their family, it comes with immense stress, fear, anxiety, missed work, high costs, and the agony of wondering if they will make it through without complications. 

For most patients, cardiac procedures are life-saving and the only way to treat certain heart conditions. But in far too many other cases, these costly, invasive, and risky procedures may have been avoided by patients through a greater emphasis on preventative care— also saving their families from the anxiety and fear that comes with worrying about their loved ones. 

What if there were a way to reduce the need for invasive and avoidable procedures (and the high costs associated with them), while at the same time improving patient experience, quality of life, and healthcare outcomes? It may sound like wishful thinking, but it could be a practical reality through digital care. 

Waste in The U.S. Healthcare System

Many heart procedures can be avoided or are unnecessary.
Photo credit: Olga Guryanova

The fact that the U.S. healthcare system is wasteful hardly qualifies as breaking news. But what may come as a shock is just how much is wasted: $935 billion per year, or 25% of total medical spending

What is driving this vast and growing waste? There are several factors, but over-treatment has been on the usual suspects list for decades. Over-treatment in the U.S. is estimated to cost $75.7 billion to $101.2 billion per year, including avoidable surgeries, invasive procedures, diagnostic testing, imaging, and prescriptions. In addition to driving excess costs, waste in healthcare is also increasingly being recognized as a cause of patient harm.

An Ounce of Prevention and a Pound of Cure: Over-Treatment in Cardiovascular Care 

Let’s take a closer look at an area that is responsible for an alarming volume of over-treatment: cardiovascular care. Cardiovascular disease is the leading cause of mortality in the United States for both men and women and the most expensive chronic condition, costing about $363 billion each year. Hypertension is one of the most important risk factors for development of cardiovascular disease, and early detection and management of it can be key to catching risk in time and potentially saving lives. 

79% of patients with hypertension do not have adequate control of their blood pressure, putting them at risk of suffering from progressive cardiovascular disease and undergoing invasive procedures that could have been avoided. But the cornerstone of healthcare in the U.S.—the fee-for-service system—misaligns incentives by placing greater emphasis on expensive procedures and therapies rather than focusing efforts on prevention. In some cases, the fee-for-service construct has also contributed to fraud, waste, and abuse

Stents are one of the most common procedures performed in cardiac patients. But are they always necessary? In certain settings, accumulating clinical evidence suggests otherwise. Several research studies and clinical trials have shown that patients with non-acute and stable coronary artery disease who received stents had no significant difference in clinical outcomes with respect to mortality or risk of major adverse cardiac events, compared to patients who only received medication and lifestyle intervention. One study found that a staggering 1 in 7 stent procedures for patients with stable heart disease and minimal symptoms are unnecessary.

Invasive treatments don’t come cheap. The average cost of a stent procedure is $32,200, and the average cost of coronary artery bypass grafting surgery is $151,271. While many of these procedures are appropriate and life-saving, in many cases they are potentially avoidable and may not result in better clinical outcomes or survival. Reducing avoidable and unnecessary procedures would translate to billions of dollars in healthcare spending each year.

The Human Toll of Over-Treatment

Consider a patient about to undergo cardiac stenting. Imagine the stress and anxiety they are feeling. Fear of complications is also not unjustified because there’s a 1-2% chance that a blood clot will form—which increases the risk of heart attack or stroke.

Now imagine that this procedure turns out to be one of the 1 in 7 unnecessary stents that are performed on patients with non-acute heart disease. How must it feel to know that all the stress, pain, and risk from a stenting procedure could have been avoided? While invasive procedures may be required and remain a possibility, they should be considered as a last resort instead of a first option.

Patients who are convinced that stenting or surgery are the only options in all clinical scenarios—when credible peer-reviewed medical research suggests otherwise—are the real victims of over-treatment. Their pain and suffering may not show up on a spreadsheet, but it’s absolutely real. 

Lifestyle Change and Medication Are the Solution — but Adherence Can Be a Problem 

For managing high blood pressure, the American Heart Association and American College of Cardiology recommend medication and lifestyle management. According to Dr. Sanjeev Aggarwal M.D., System Chief of Cardiovascular Surgery and Clinical Innovation Officer at Beaumont Health, and Medical Advisor at Hello Heart, “Invasive procedures and surgeries without the corresponding changes in lifestyle and evidence-based medical therapies ultimately leads to the need for reintervention and more procedures downstream.” Healthy habits and preventative care can help patients avoid costly treatments. But this remains a challenge when patients don’t comply with lifestyle modifications and don’t take their medications.

Traditional disease management and blood pressure tracking programs have tried (and largely failed) to fix this. Fortunately, there’s an innovative, technology-led approach that’s making a big difference—digital care.  

The Way Forward: Digital Care 

Employer-sponsored insurance is the most common type of health coverage in the U.S., with more than 181 million Americans—virtually half of the population—depending on it. Employers are in a powerful position to improve quality of care while helping reduce waste in the healthcare system by offering digital care as an employee benefit.

Digital care bridges the gap between self-care and traditional care, empowering patients in their own health care journey.  It does this through highly personalized, clinically-based digital coaching and medication reminders that are securely delivered to patients. There are four pivotal advantages:   

  • Patients can achieve better outcomes at lower cost by reducing the need for expensive and avoidable procedures. A peer-reviewed study of 28,189 participants observed that greater engagement with the Hello Heart app was associated with better blood pressure management, with follow-up as long as 3 years.1

    Better clinical outcomes may translate into significant cost savings. In an analysis commissioned by Hello Heart, the Validation Institute analyzed employer claims data from 203 Hello Heart users and 200 non-users and found that Hello Heart users’ estimated CVD costs went down by $880, while matched non-users’ estimated CVD costs increased by $985—representing a reduction of estimated employer CVD spend of $1,865 per participant per year.2
  • Interventions that focus on prevention and management—like the Hello Heart coaching app—can help people with high blood pressure make healthier choices and form new habits, which in turn may help them lower their blood pressure and subsequently lower their risk of heart attack or stroke.

  • Patients get practical and jargon-free education to understand their condition, which promotes lifestyle change and enhances self-care. For example, Hello Heart takes the mystery out of blood pressure numbers and terminology so that patients understand what they actually mean — and feel empowered instead of intimidated.
  • The “shame barrier” is eliminated. Patients interact with AI-driven digital coaching through their smartphone instead of having to go into a doctor’s office.

Changing the Game 

High spending in the U.S. healthcare system from over-treatment and lack of prevention is enormous and growing. If you had the chance to avoid the bright white hallways of a hospital and the physical, emotional, and financial cost of a cardiac procedure, wouldn’t you?

It’s time for a fresh new approach—one that meets people where they are and helps them make positive, healthy changes. And it’s through those changes that better health outcomes and cost savings are possible. This solution is digital care, and it’s changing the game.

Footnotes:

1: Gazit T, Gutman M, Beatty AL. Assessment of Hypertension Control Among Adults Participating in a Mobile Technology Blood Pressure Self-management Program. JAMA Netw Open. 2021;4(10):e2127008, https://doi.org/10.1001/jamanetworkopen.2021.27008. Accessed 4/6/2022. (Some study authors are employed by Hello Heart. Because of the observational nature of the study, causal conclusions cannot be made. There were 108 participants who had been enrolled in the program for 3 years and who had application activity during weeks 148-163. See additional important study limitations in the publication.)

2: Validation Institute. 2021 Validation Report (Valid Through October 2022). https://validationinstitute.com/wp-content/uploads/2021/10/Hello_Heart-Savings-2021-Final.pdf. Published October 2021. Accessed 4/6/2022. (This analysis was commissioned by Hello Heart, which provided a summary report of self-funded employer client medical claims data for 203 Hello Heart users and 200 non-users from 2017-2020. Findings have not been subjected to peer review.)