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Even with recent attempts to improve healthcare delivery, the U.S. healthcare system continues to face major challenges. According to 2019 data from the OECD, the U.S. spends 16.9% of gross domestic product on healthcare, nearly double that of the average developed country. Despite all of this spending, the U.S. also ranks last amongst the top 11 most developed countries for life expectancy and ranks first in chronic disease burden and hospitalizations due to preventable causes.

Healthcare utilization often trends upward significantly for high-need, high-cost (HNHC) individuals, accounting for as much as 50% of overall healthcare spending on just 5% of the total population. Unfortunately, much of this care offers little — if any — benefit for HNHC individuals. In fact, Reuters has reported as many as 42% of Medicare members are subjected to procedures providing little to no medical benefit. For health plans, this unnecessary care can cut steeply into margins, amounting to $270 billion wasted on unnecessary care annually in the US.

AUSTIN — November 2019 –  Iris, Inc. (www.irisplans.com), a visionary leader in Advanced Care Planning (ACP) solutions for health plans and other risk-bearing organizations, has partnered with IlliniCare to provide ACP services for IlliniCare Health’s Dual Eligible Special Needs (DSNP) members. 

Like all companies in the healthcare space, health plans have been financially impacted by COVID-19 — but not in the way most would expect. To preserve hospital resources and PPE for COVID-19 patients and reduce the risk of unnecessary exposure to the virus, most elective and non-essential care was cancelled or delayed beginning in mid-March. Additionally, some patients opted to delay necessary care due to fear of entering healthcare facilities.

This article first appeared on Hawaii Tribune Herald

For health plans, advance care planning (ACP) achieves a lot more than just documenting member care preferences; ACP is critical for helping your plan:

Months into the COVID-19 pandemic, many unknowns remain about the virus’s impact on our health, jobs, social life and economy. But one clear impact of COVID-19 is the importance of planning for your care before you need it — otherwise, you risk having others make your care decisions on your behalf.

For healthcare plans, achieving member quality of life goals can be challenging. Member goals differ on a case-by-case basis; documenting and following these goals requires time, expertise and consistency from every person involved in a member's care.

People living with serious medical conditions often spend a lot of time in hospitals. As their illness progresses, the number of hospital visits and the amount of time they spend in the hospital may increase. With each stay, the amount of stress, uncertainty, and even fear that patients and their loved ones feel may increase, too.