What Healthcare Executives Can Do to Curtail Rising COPD Costs

Because most patients with undiagnosed chronic obstructive pulmonary disease (COPD) adjust their lifestyle to address their symptoms, diagnosis occurs much later in disease progression, resulting in escalating costs for treating exacerbations through hospitalizations and emergency department visits.

Managed Healthcare Executive (MHE) asked Christopher Blanchette, PhD, MBA, an associate professor of public health sciences at the University of North Carolina at Charlotte, to articulate the challenges that COPD patients face and how COPD expenditures might be reined in.

MHE: How do COPD patients mask their symptoms?

Blanchette: They might take the elevator instead of the stairs or they might stop being as active as they used to be; hence, they end up being diagnosed at stage 3 instead of stage 1.

It is important that these patients receive an earlier diagnosis by better screening patients who are current or former smokers and have the symptoms of wheezing, coughing, and/or sputum production.

MHE: What is the roll of controller therapy in reducing COPD costs?

Extremely important. Once a definite COPD diagnosis has been made, the patient should be immediately placed on a type of controller therapy. But adherence to the medication is key.

Controllers all have different breathing systems. However, sometimes the patient does not use the correct system or the device does not work for them. Therefore, the patient does not receive the benefits of the drug, so they end up in the emergency room or hospital.

Patients also need to be shown how to use an inhaler and providers should ensure that patients can use the device before being discharged. Additionally, if the drug tastes bad or makes the patient’s mouth dry, the patient may discontinue use completely.

The reality is that 20% of COPD patients are responsible for 80% of the cost, which now stands at roughly $50 billion a year in the U.S. Just between 2003 to 2010 alone, costs increased from $32 billion to $39 billion. The disease is still out of control.

MHE: Isn’t that due largely due to increased prevalence, though?

Blanchette: Yes, but COPD is a dormant disease. For example, smokers end up with COPD 20 to 30 years after starting smoking, despite the fact that the rates of smoking have decreased over the past 10 to 15 years.

The sheer volume of older adults is also contributing to rising COPD costs.

Next: What can healthcare organizations do to reduce COPD expenditures?

MHE: What can healthcare organizations do to reduce COPD expenditures?

Blanchette: More white glove services like care managers and more coordinated care are needed because the cost is not limited to COPD. For instance, congestive heart failure is a comorbid disease that occurs in most COPD patients.

You also want to make sure patients are using their medications appropriately.

Using predictive analytics to identify high-cost COPD patients is helpful as well, plus employing care managers to follow-up with patients to make sure they are seen at the clinic.

Encouraging patients to embrace new inhaler and nebulizer technology can also reduce cost by the provider team being sent information remotely about user compliance.

MHE: Going forward, do you anticipate that COPD costs will diminish?

Blanchette: Unfortunately, costs are expected to continue to rise sharply, unless we take drastic measures.

I recently conducted a study that showed there has been no change in curbing these costs over the last 30 years. Therefore, healthcare systems need to invest in measures, not only for the patient but also for the healthcare systems themselves and their own cost sharing to help manage these patients.

While in the past, most healthcare institutions have employed a fee-for-service model, now more healthcare systems are taking on more risk-sharing agreements with a focus on population health and an emphasis on reducing long-term costs, which has really been the problem for COPD patients.

Up until now, there has not been an incentive in place to reduce costs. But with new payment models, there are more incentives for healthcare systems to keep people out of the hospital and the emergency room. Controller therapy and ensuring patient compliance are crucial.