By: Dr. Timothy Dudley, Medical Director
We took a deep dive into the Anthem Commercial cost data and would like to share our findings with you.
Our biggest opportunities lie with site of service for musculoskeletal procedures and GI procedures. 47% of our musculoskeletal procedures were performed in a hospital rather than an outpatient facility compared to the national benchmark of 24%. Similarly, 48% of our GI procedures were performed in a hospital rather than an outpatient facility compared to the national benchmark of 5%. This results in a cost opportunity of $632,000 and $445,000, respectively. It’s worth discussing these findings with our specialists. Frequently, just showing them the data and asking for their help is sufficient. If you would like our help in any of these conversations, please don’t hesitate to ask.
Our next biggest opportunity lies with pharmacy costs. In the treatment of hypertension, switching our patients from telmisartan to losartan will result in significant savings. In the treatment of migraine headaches, switching from high cost triptans to sumatriptan succinate and rizatriptan will be far less expensive. And lastly, in the treatment of anxiety and depression, switching from high cost SNRI’s to older generic SNRI’s will also result in significant savings.
As always, feel free to reach out to me at any time at tim@chpanetwork.com with any questions, concerns, or comments.
