Missed Doses Don’t Stay Small. They Turn Into Inpatient Days for Health Plans.

Key takeaways for health plan leaders:

A rushed trip to the emergency department. An unexpected hospitalization. A cardiac procedure that lands without warning and immediately pressures medical loss ratio.

As a cardiothoracic surgeon, I’ve spent decades caring for patients at the far end of cardiovascular risk. Today, that experience informs how I think about prevention at the population level. From both perspectives, these events are rarely sudden.

They are slow burns. Predictable, measurable, and—most importantly—preventable years before a member ever reaches an operating table.

As health plans finalize 2026 strategies amid sustained cost pressure, this distinction matters. The most effective path to cost containment is not reacting faster to events. It is acting earlier on the signals that quietly build risk over time.

This year, reducing missed doses and sustaining blood pressure control are the most measurable, actionable forms of cardiovascular prevention—and the clearest opportunities to influence downstream utilization.

The Cost Problem Starts Years Before the Hospital

The earliest cost drivers rarely announce themselves as crises.

In patients I’ve cared for, cardiovascular disease most often unfolds through years of gradual change: rising systolic blood pressure, readings that swing up and down over time, metabolic changes, and on-and-off medication routines.

These patterns typically develop 12 to 36 months before an acute event. During that time, members often feel fine. They continue working, exercising, and living their lives. But beneath the surface, damage is quietly accumulating.

From a utilization perspective, gaps in blood pressure control and patterns of missed doses are among the most reliable early warning signs of future acute care. When left unaddressed, they frequently surface later as avoidable emergency department visits, hospitalizations for heart failure or stroke, and referral paths that get expensive fast.

By the time a member lands in the emergency department or is admitted to the hospital, the opportunity for low-cost prevention has largely passed. Care shifts from managing chronic risk to ICU beds, procedures, and repeat admissions.

For health plans under pressure to manage medical trend, this is the moment where cost either stays manageable—or becomes expensive.

Why Adherence Is a Prevention Strategy

Medication adherence is often framed as a quality or compliance metric. Clinically, it functions as something far more important: a signal of how much cardiovascular risk is quietly accumulating.

Cardiovascular disease is progressive and often silent. Blood pressure and plaque buildup do not require symptoms to cause harm. Many heart health medications work by reducing long-term damage over time, not by producing an immediate, felt benefit.

That creates a predictable challenge. When a member misses a dose and feels fine, they have no idea they’re at risk. Over months and years, inconsistent medication use accelerates changes that later drive heart attacks, strokes, kidney disease, and heart failure.

As a surgeon, I see the consequences years later. Patients present with advanced disease that reflects long periods of intermittent treatment, not sudden breakdown. From a cost perspective, those years of inconsistency translate directly into higher downstream utilization.

This is why adherence belongs at the center of the prevention conversation. Taking medications consistently is one of the most reliable ways to delay—or avoid—high-cost events long before members feel unwell.

The Between-Visit Problem

One reason cardiovascular risk is so difficult to manage is that risk is continuous, while traditional care remains episodic.

Most members interact with the healthcare system only a handful of times each year. In between visits, months of rising blood pressure, missed doses, or disengagement occur outside clinical visibility. Real-world barriers—work schedules, transportation challenges, side effects, and low health literacy—make that gap even wider.

By the time a concerning pattern appears clearly in the medical record or claims data, the window for early correction has narrowed. Intervention becomes reactive by default.

From a population health standpoint, this creates a structural blind spot. Risk builds quietly between visits, while plans are left responding after utilization has already surfaced.

What Gaps in Control Signal at Scale

When gaps in blood pressure control or patterns of missed doses emerge across a population, they are not isolated clinical failures. They are leading indicators of future cost acceleration.

At scale, low control rates are associated with higher emergency department use, more hospitalizations, and progression to complex cardiovascular disease that requires specialist care. Utilization shifts from manageable outpatient settings to repeated acute encounters.

This is why measures such as Controlling Blood Pressure (CBP) matter beyond regulatory reporting. Clinically, sustained blood pressure control reflects whether vascular disease is being stabilized—or allowed to progress.

When control rates decline, higher-cost events often follow. Quality measures don’t cause cost, but they do surface where preventable cost is already accumulating.

Continuous Risk Management Changes the Curve

For health plans, effective cardiovascular prevention in 2026 requires a shift from event-based intervention to continuous risk management.

That means:

• Ongoing visibility into blood pressure trends, not single-point readings
• Support for reducing missed doses between visits
• Rapid feedback loops when control begins to slip
• Early escalation before thresholds are crossed and utilization spikes

Outcomes are driven by what happens on the 364 days between visits, not the single annual encounter.

When plans act on real-time clinical and behavioral signals, they can intervene while risk remains modifiable. This is where outcomes and cost curves can still change—and the data backs it up.

A Value in Health study found an 18% reduction in medical costs per participant per year, driven largely by fewer inpatient days. Those savings highlight how sustained cardiovascular risk management can meaningfully reduce high-cost utilization.

Results vary by population and engagement level, but the pattern is consistent: earlier intervention—before risk escalates into acute care—is associated with better outcomes and lower downstream cost.

The Cost of Inaction

In Q1, health plans aren’t just setting priorities. They’re setting trajectories. Decisions made in the first quarter determine which risks get actively managed and which quietly compound over the rest of the year.

Waiting six or twelve months allows reversible cardiovascular risk to harden into structural disease. Uncontrolled blood pressure and missed doses accelerate changes that are far more expensive to unwind later, shifting care from prevention to emergency intervention.

Plans that act early—by identifying rising risk trajectories and closing the between-visit gap—create conditions for lower emergency and inpatient utilization as the year unfolds.

This is where prevention turns into measurable financial impact.

Managing the Slow Burn

At its core, this is a cost story.

Cardiovascular events are rarely sudden. They are predictable, measurable, and preventable.

The clinical signals appear years before hospitalization. Plans that act on those signals early can reduce avoidable acute care, improve outcomes, and materially influence cost.

Every day of consistent medication use and sustained control shapes long-term cardiovascular risk—and long-term cost. In a year when cost containment has never mattered more, managing the slow burn is one of the most effective strategies available.

Adherence is the new prevention.

See how Hello Heart partners with health plans to act earlier on cardiovascular risk—before missed doses turn into inpatient days.