By: Nate Szabo, Cost Containment Consultant
Digestive diseases, or gastrointestinal disorders, are ailments of the digestive tract, including the esophagus, stomach, intestines, liver, pancreas, and gallbladder. These diseases have become a growing problem in the United States, placing a financial burden on individuals as well as their employer-sponsored health insurers. Digestive disorders are responsible for an extraordinary number of clinical visits and hospitalizations each year. In fact, the Massachusetts Medical Society estimates that overall annual expenditures for digestive disease care totaled more than $136 billion.
Digestive disorders include conditions such as irritable bowel syndrome (IBS), hemorrhoids, constipation, and colitis. Many of these diseases can be prevented or minimized by maintaining a healthy lifestyle or taking over-the-counter remedies. However, due to a lack of education regarding digestive disease care, gastrointestinal disorders are responsible for nearly 6 million emergency room visits each year.
Roundstone’s Cost Saving Investigators (CSI Team) recognize the high-dollar claims associated with digestive disorders. That’s why we continuously analyze our clients’ healthcare spend to recommend any potential solutions to realize tangible cost-saving opportunities. Below is a real-life solution we implemented for one of our employer clients with an employee suffering from a digestive disease.
Digestive Disease Care Management
A blue-collar organization, enrolled in one of Roundstone’s medical self-insurance pools, was experiencing higher than average medical claims. One of Roundstone’s cost containment consultants took a closer look into the claims and identified an employee with a diagnosis of ulcerative colitis.
Ulcerative colitis is an inflammatory bowel disease that can be managed through medication, dietary measures and stress control. To successfully reduce costs and increase overall quality of life, the CSI Team recommended a 100% digital intervention service to successfully manage digestive disorder symptoms. The program offered a personalized approach to sustainable symptom relief for individuals with inflammatory bowel diseases (IBS). The year-long program is individualized and consists of three phases—symptom relief, nutritional testing, and digestive disease care maintenance. According to the Cleveland Clinic, some of the best ways to treat IBS include:
- Avoiding caffeine
- Increasing fiber in the diet
- Monitoring and avoiding trigger foods
- Minimizing stress
The program recommended is designed to reduce or eliminate emergency room visits. Plus, the program could potentially reduce the use of specialty pharmaceuticals by identifying triggers and adjusting dietary habits. Many popular prescription drugs for ulcerative colitis can be expensive, costing more than $38,000 a year. With a total cost of $385 per participant per year, the digestive program recommended by the CSI Team offers a minimum savings of $1000 per avoided emergency visit and potentially more savings on specialty drug spend.
Impact of Digestion Program Care
The digestive management program also provides personalized access to registered dietitians to assist members throughout their progress through the program. After completing one year of the program, 93% of participants reported symptom improvement. Additionally, 43% of participants reported experiencing symptom reversal.
Besides saving money in the long-run, employers who enroll their employees in the digestive disease care program experience a reduction in employee absenteeism and short-term disability coverage utilization. Furthermore, the program drastically decreases the likelihood of emergency room visits. With the right treatment plan, employers and their employees diagnosed with a digestive disorder can realize significant savings.
The Roundstone CSI Team is here to help employers of all shapes and sizes realize cost-saving opportunities while also increasing their employees’ quality of medical care. Interested in learning more? Contact Roundstone to learn how our consultants can help your company save on rising health care costs.
About the Author:
Nate Szabo is a graduate of John Carroll University and brings experience from the medical device and healthcare industries—providing innovative solutions to Roundstone’s employer clients.