... and why does it matter?
Jim was taking a daily medication for the purpose of preventing a condition that was largely an elective intervention. Jim's doctor recommended a newer option in the market that is a 1-time intervention. Jim considered the options and opted to move forward with the 1-time intervention.
Shortly after the procedure, Jim began experiencing symptoms that typically were not issues previously. The physician identified these symptoms as side effects and recommended to stay the course because the side effects typically resolve within 6 months. Nine months later, these symptoms persisted, including migraines/headaches and high blood pressure. The physician recommended Jim see 1 other provider to address one symptom while the attending physician would address other symptoms. The physicians separately recommended additional medications to manage those symptoms. And considering those medications will have their own side effects, Jim decided to reverse the 1-time procedure.
Jim was chasing symptoms with more medication from an intervention that was essentially an elective measure, or also called a medical cascade. One issue is addressed, but the intervention leads to secondary symptoms that require their own intervention.. and so on. Most people do not have the confidence to question the physician or push to change course.
Medical cascades are an example of over-treatment, which naturally leads to increasing healthcare costs for the individual and employer-sponsored health plan. This over-treatment is compounded by the lack of transparency in purchasing medications, diagnostics or treatment. The result? unchecked, expensive medical claims and increasing premium.
What Can Employers Do?
1. Provide education and training to employees so they can identify medical cascades and engage in the conversations with their medical provider.
2. Provide shopping tools and resources to aluminate the cost of prescriptions drugs as well as alternatives.
3. Review claims data to uncover where these expensive nuggets exist within the plan.