Lost Value: 3 Ways Health Plans Can Maximize Potential in Wound Care

Value has been a major buzzword in healthcare for the past few years. As patients become consumers, they are looking for more value in the care they receive. Providers are looking for more value in the care they deliver. Health plans are looking to recognize value for their members and their bottom line.

What does that look like?

On the surface, value is a pretty simple formula in healthcare. It is the melding of cost with results or outcomes. Everyone wants to get the best results possible for the amount they spend. It’s a little murkier in healthcare where costs and outcomes aren’t as transparent as buying a fast-food combo meal, but most patients and organizations know value when they see it.

So why aren’t we achieving value when it comes to wound care?

It’s a tough question to answer. Health plans have a tough job in front of them. With a shifting landscape and numerous disruptors, managing the health of a large member population grows more challenging every day. In its current state, wound care is handled in specialized wound care clinics, at provider offices, and through home health. Without going into too much depth, it is often difficult for patients to reach wound clinics which leads to missed appointments and non-standardized treatment. In the home health setting, there is a lack of wound care experience and inconsistent processes, yielding unreliable results.

This is a problem that must be addressed. With 8.8 million chronic wounds diagnosed each year and a 15% wound prevalence rate for Medicare patients, the problem is massive. But so is the opportunity.

Health plans can deliver value to their members by looking at three things:

Efficient Processes

There’s a better way to do things. Instead of relying on what materials are available or the differing levels of experience of nurses, patients need consistent, evidence-based processes. Wound care clinics frequently use dressings and other supplies based on what they have in stock. Home health agencies often apply the same treatments to patients regardless of wound type without appropriately changing the treatment plan as the wound characteristic condition changes. We need defined processes that address the unique needs of each patient’s wound. Technology can play an important role in standardization.

Cost Savings

Treating wounds is expensive. Annually, wound care costs Centers for Medicare and Medicaid (CMS) an estimated $117 billion. Quantifying the illness burden of wound care on a given member population is complex, but we know that there is significant potential for cost savings coming from both operational efficiencies, utilizing wound care experts, and achieving reduced admission and readmission rates. By rethinking how we treat wounds, we can lower our costs while delivering better results. It all starts with delivering the right care, at the right time, and in the right place.

Better Outcomes

Currently, more than 70% of complex wound patients are admitted or readmitted to the hospital for treatment before the wound is healed. That is not in the best interest of the patient and it’s also incredibly expensive. To reduce admissions and readmissions while lowering costs, we must create a consistent experience that delivers value. At Esperta Health, 71% of wounds we treat heal faster than the industry average. That equals value for the patient and for the health plan.

Regarding health plans, there is a path to create value for members with chronic wounds. Through new processes that focus on specialized, in-home, evidence-based wound care, we can deliver better outcomes at a lower cost, thus maximizing the value for health plans.