You’re an African-American woman – college educated, middle-aged and slightly overweight. Your knee arthritis is getting worse and you have a decision to make: Should you muddle through on pain relievers, gradually becoming less and less active, or consider treatments like joint replacement? If you could know in advance the cost of delaying treatment – to your future wages, physical effects of immobility and quality of life – that might inform your decision.
In a Monday session, “Case Study: Patient Engagement Is Critical to the Success of a Value-Based Health Care System,” part of the third annual U.S. News Hospital of Tomorrow forum, medical and health-disparity experts explained why it’s critical to enable such decisions for patients, health care systems and the nation. David Dvorak, president and CEO of Zimmer Biomet, Inc., moderated the session.
Their challenge: meeting the needs of an increasingly diverse group of patients. These patients might previously have lacked access to the health care system and now enter with higher levels of chronic conditions such as obesity, diabetes, heart disease and arthritis.
Their focus: reducing the unequal burden of health care costs and personal disability related to musculoskeletal conditions.
Their pilot plan: use a knee arthritis cost model to engage patients in healthier behaviors. Giving patients a glimpse into their futures – in terms of life of expectancy, quality of life, health care expenses and lost wages – could help influence their medical treatment and lifestyle choices. This framework is intended to promote shared decision making and make the most of value-based health care.
“No treatment does cost us – it’s the most expensive option,” said panelist Dr. Mary O’Connor, director of the Musculoskeletal Center at Yale School of Medicine and Yale-New Haven Hospital. “Disparities are real and costs [fall onto] three stakeholders: patients, employers and health systems.”
The costs of U.S. health and health care disparities reached $1.2 trillion dollars in a four-year period, said panelist Darrell Gaskin, an associate professor of health economics and deputy director of the Center for Health Disparities Solutions in the Bloomberg School of Public Health at Johns Hopkins University.
O’Connor explained the “vicious cycle” of joint pain, limited mobility, lack of physical activity, obesity, increased pressure on knee joints and joint pain. Heart disease, type 2 diabetes and depression are then more likely to follow. These related conditions might make treatment appear riskier to providers and possibly discourage needed interventions. For a variety of reasons, African-American and Hispanic women face higher lifetime costs than white women from knee arthritis, O’Connor said.
A video featured focus-group patients in Baltimore who described the effects of arthritis on their activity level and work life, such as a woman forced to reject career opportunities that would have improved her financial future, because knee-related pain and immobility prevented her from performing job functions.
Using the patient-engagement tool and cost model, providers were able to directly show among possible scenarios, the positive impact treatment would likely have on patients’ future ability to drive, work and stay independent.
The new cost-model tool allows health providers to plug in assorted factors, such as age, weight, sex, education, race/ethnicity and coexisting conditions. Doctors and nurse practitioners can show patients how different treatment courses are likely to influence their health care costs, work future and quality of life – in one year, five years and even 20 years.
This individualized model engages patients in an innovative way, O’Connor said. And when patients buy in to a healthier approach, she said, everyone benefits, including employers and health care systems. Gaskin noted that patients’ adherence to treatment, once agreed on, will be addressed in the next pilot phase.