Cost savings and better outcomes: The value of experience in wound care

Wound care is at a critical juncture. As healthcare spending continues to increase, payors are looking for solutions that will lower costs while delivering better outcomes. This quest for value is defining the industry as more players look to disrupt the status quo and drive meaningful change.

In wound care, the use of inexperienced clinicians, too often, leads to suboptimal results and expanding costs. By better aligning our wound care strategy with our quest for value, we can deliver results that make sense for patients and health plan administrators. It all starts with the clinicians.

Who is treating wounds?

Experience matters when it comes to wound care. As we talk with patients and providers, we are finding a wide gap in experience and training for clinicians treating wounds. In many cases, patients are receiving care from home health nurses, who do not have wound-specific training and certification. We’ve even seen wound care being provided by physical therapists and other non-wound care certified clinicians. The same can be true at the outpatient wound clinic.

Similarly, there is no standardization in the care patients receive. Health plans need consistent quality in wound care to ensure their members receive the care they need to heal and begin their journey to wellness. This lack of expertise and access to wound care certified clinicians creates inconsistent care. Ultimately, this leads to sub-standard results including missed diagnoses, longer healing times and over 70% readmission rates for some complex wounds.

What does it cost?

Providing wound care in the U.S. is expensive. Looking at the big picture, wound care costs the Centers for Medicare and Medicaid (CMS) an estimated $117 billion annually. That number is so big it’s hard to contextualize, but if we break it down by patient, we see that the average cost for CMS is $13,355 per case.

But what are payors getting for that number?

We continually see patients that are being treated by home health for 8-10 months and still end up admitted to an inpatient facility. In fact, we’ve seen that patients are receiving care from an inpatient setting far too often, making up about 50 percent of a health plan’s total wound spend. For the amount they are spending, health plans should expect better results.

Are patients seeing better outcomes?

For the investment health plans make, you would expect to see excellent outcomes for patients, but the outcomes do not seem to match the investment. As is the case in many areas of healthcare, expenditure is not an accurate reflection of patient outcomes. We are also seeing large gaps in care. Most chronic wounds should be seen weekly, but the data shows that many patients go 30-48 days without any wound treatment. A lack of consistency for wound care leaves little hope for optimal healing time and drives the utilization of inpatient care, which greatly increases cost.

The need for consistent quality in wound care is pivotal to delivering sustainable results for health plans. This means health plans need to rely on experienced clinicians who understand the latest in wound care treatment. By delivering the right care at the right time in the right place, health plans can create value for their members, deliver better outcomes, and recognize significant savings.