Wound care in the U.S. is expensive—too expensive. Wound care costs CMS an estimated $117 billion annually, which is driven largely by the approximately 8.8 million Americans impacted by chronic, non-healing wounds. Imagine the improvements we could fund and make to the healthcare infrastructure if we could significantly reduce the chronic wound care spend.
So, what’s driving up the cost?
Infections have a significant clinical and financial effect on patients and health plans. It goes beyond just the outcome. Infections account for a significant increase in the cost of treating chronic wounds. Through our experience, we have found that more than 60% of health plan members with chronic wounds end up with an infection in that wound.
Looking only at diabetic foot ulcers (DFU) in claims data from plans without wound care programs, we see infections in 50% of DFUs and, of those, 20% required amputation. The result of this is way too many amputations. Infections in chronic wounds leave health plans saddled with higher cost for wounds that likely could have been healed in a timely manner, if treated earlier, avoiding infection. By reducing infection rates in chronic wounds, we can keep patients out of the hospital and reduce amputations.
In addition to infection, wound recurrence drives the increase in health plan wound care spend. For example, venous leg ulcers recur 60%-70% of the time. In a fee-for-service model, having to treat a wound more than once exponentially increases costs without ensuring a favorable outcome.
It’s a fact. Wounds will recur, but we can drastically lower recurrence rates with regular treatments that adhere to evidence-based standards of care. This means having the resources in place to closely monitor the wound’s healing progress and treat patients with consistent wound dressings and materials. Wound care plans are not one-size-fits-all. Instead, they should be individualized to each patient and should be responsive treatment plans that adapt to the changing condition and healing rate of the wound.
Lack of Consistent Care
At the root of the problem, patients are not receiving consistent, quality care. Too often they miss appointments due to financial, transportation, or health barriers. This is where the social determinants of health come into play. While most wounds are treated in an outpatient wound clinic, patients miss nearly half of their appointments. A 50% no-show rate represents a missed opportunity and barrier to delivering much needed care.
This translates into gaps in care. The data shows that many patients go 30-48 days without any wound treatment. By not receiving the right care in the right place, patients are at a disadvantage, which leads to increased infection rates and readmissions. As we’ve previously mentioned, those elements lead to increased costs for health plans.
We’ve seen that wound care costs for a single case can be as much as $100,000 or more. . That is unsustainable and we must be focused on reducing costs to build a healthcare infrastructure that delivers value and improved outcomes. Esperta Health’s innovative model improves care delivery and outcomes with a wonderful consequence, cost savings. Better results, faster healing in the home, and lower wound care costs represents the next evolution of population health that will drive results in the long and short term for health plans.