What is an ounce of deferral worth?

So, if an ounce of prevention is worth a pound of cure, how much is it really worth? What about an ounce of deferral? Who pays the price and realizes the potential benefits?

The answer, as you would guess, is not simple. However, if we are to migrate from a disconnected US sickcare system of systems to an interoperable healthcare system that uses a value based business model instead of a fee for service one, then the answer will, in part, drive the speed and depth of the BIG FIX dissemination and implementation.

Here are some deferral management cases for morning report:

1. A value based surgical management company offers a network of surgeons who offer high percentile outcomes for a bundled price. What is the value of a procedure that is denied or deferred and how do we account for the costs and benefits?
2. A radiology decision support company creates an algorithm to reject imaging orders , like an MRI for back pain, that are not indicated within 4 weeks, as determined by evidence based guidelines. How much does it save?
3. A medical travel company offers patients in countries with long waiting lists a network of surgeons willing and able to do their procedures in a few weeks or days instead of a few months in another country. What is the cost/benefit?
4. Is deferral management "rationing" or just a prudent way to eliminate the approximately 1/3 of waste in a $3.7T budget?

Indeed, some evidence does suggest that there are opportunities to save money and improve health through prevention. Preventable causes of death, such as tobacco smoking, poor diet and physical inactivity, and misuse of alcohol have been estimated to be responsible for 900,000 deaths annually — nearly 40% of total yearly mortality in the United States.1 Moreover, some of the measures identified by the U.S. Preventive Services Task Force, such as counseling adults to quit smoking, screening for colorectal cancer, and providing influenza vaccination, reduce mortality either at low cost or at a cost savings.

Sweeping statements about the cost-saving potential of prevention, however, are overreaching. Studies have concluded that preventing illness can in some cases save money but in other cases can add to health care costs.

The costs and benefits of deferral management are difficult, if not impossible to determine with certainty. AI and data analytics might help us narrow the distribution for a particular patient with a particular diagnosis, however.

Chronic care management and referral management systems are designed to optimize indicated care pathways, referral leaks and dropped handoffs.. Deferral care management systems are designed to minimize unnecessary interventions in illnesses that, by their natural history, will resolve in most instances with sufficient time and with supportive or symptomatic relief, like colds, sinustitis, ear infections, back pain and musculoskeletal sprains. Costing deferrals will require advanced analytics, particularly when attempting to predict those at risk or progressing instead of resolving.

Suppose you just swiped your credit card to contact your teledoc? The deferral management system indicates no treatment is necessary, since about 40% of encounters involve the upper respiratory system that, in many instances, will get better without antibiotics or other prescription drugs. Congratulations. You just saved a bunch of money not having to buy those expensive prescription drugs. Feel better now? Don't forget to renew your rising health insurance payment and check your credit card charge of $50 for the treatment you didn't receive.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Twitter@ArlenMD and Co-editor of Digital Health Entrepreneurship