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Monthly healthcare insights: Rising healthcare costs, artificial intelligence

By Jeff Levin-Scherz, MD, MBA | August 12, 2024

Our population health leader weighs in on rising healthcare costs, artificial intelligence and patient questions, cancer and more.
Health and Benefits
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The impact of rising healthcare costs on the economy, jobs and mortality

Academic researchers in collaboration with data scientists at the Internal Revenue Service (IRS) published a pre-print this spring exploring the impact of allowable charge increases on labor force and the economy. This is an ingenious study; the researchers evaluated the impact of hospital mergers from 2010–15, which caused an average price increase of 1.2% in these communities. They used medical claims from the Health Care Cost Institute, Department of Labor filings for healthcare costs and individual tax filings from the IRS. About a fifth of mergers led to a 5% increase in prices.

The researchers found that a 1% increase in prices was associated with:

  • Decrease of employment and payroll of 0.37% outside of healthcare, and no change of employment or payroll in the healthcare industry or in self-employment
  • Labor income decrease of 0.27%
  • Decrease in income tax payments of 0.4%
  • Increase in unemployment payments of 2.5%

The labor impact of rising healthcare costs from hospital mergers was borne by those making between $20,000 and $100,000. Those earning under $20,000 were likely not on employer-sponsored health insurance, and higher-wage workers weren’t affected since health insurance costs make up a smaller portion of their total compensation.

The researchers also found that a 1% increase in healthcare prices led to a 2.7% increase in deaths from suicides and overdoses (one additional death per 100,000.) This is one extra death for every 140 individuals who lost their jobs due to healthcare price increases.

A hospital merger that led to a 5% increase in hospital costs would lead to 203 job losses, $32 million in foregone wages, $6.8 million in lower federal income tax payments and 1-2 additional deaths from suicide or overdose, with an aggregate harm of $42 million.

There were over 1,000 hospital mergers from 2000–20, and the researchers found that over 99% of commuting zones in the U.S. that had a hospital were exposed to a merger within or adjacent to that commuting zone.

Implications for employers:

  • This research shows that higher healthcare costs lead to fewer jobs and less economic activity, and disproportionately impact those with lower wages.
  • Job losses from healthcare cost increases lead to more “deaths of despair” from overdoses and suicides.
  • Effective efforts to control healthcare costs can improve the economy and save lives.

Artificial intelligence does a good job answering patient questions

Many of us have questions we want to ask our doctors. And most doctors are deeply fatigued by responding to the onslaught of messages in their in-boxes. Doctors complain of “pajama time,” answering patient portal questions in bed late at night. What if we could ask AI to answer these questions?

Researchers at New York University asked 16 primary care physicians to rate the quality of healthcare provider and AI responses to patient queries. They were given blinded responses (they didn’t know if they were written by physicians or AI), and the AI used to create the responses was software from Epic, the large electronic health record company. The provider responses were from a range of providers, including physicians, nurses and medical assistants.

The reviewers were more likely to find the AI responses personalized (52% vs. 38%) and empathetic (37% vs. 17%). The AI responses were longer and more likely to require a wider vocabulary for full understanding. The AI performed poorly on a few categories, especially interpretation of lab values.

Another study compared readability and information quality in cancer information from a free chatbot with answers from a chatbot that was behind a paywall. (Both were ChatGPT; the free version was 3.5, and the paid version was 4o.) The researchers evaluated 100 chatbot responses. They found that the paid chatbot produced more readable answers, although prompting the free chatbot to reword responses at a sixth-grade level eliminated this difference.

Implications for employers:

  • AI large language models continue to improve and are likely already good enough to answer basic patient questions, although a system with guardrails to prevent troublesome answers is important. Here’s a link to a post from last spring about a chatbot recommending harmful behavior to people with eating disorders.
  • Employers are already using similar technology to answer questions on benefits and programs.
  • AI is only as good as the ingested data, and we need to guard against allowing “real world” data to inject disparities and discrimination into chatbot responses.

Four in ten cancers could be prevented through risk modification

The American Cancer Society has updated its estimates of the portion of cancers in the U.S. related to modifiable risks. Researchers used cancer incidence and mortality and risk factor prevalence from 2019 to create these estimates through multiple simulations. The analysis includes 30 types of cancer but excludes non-melanoma skin cancers. The authors avoided using 2020 data due to fewer overall diagnoses during the pandemic.

Tobacco remains the number one risk factor for preventable cancer, contributing to 344,000 cases each year. Excess body weight contributes to 136,000 cases of cancer, and alcohol consumption is associated with about 97,000 potentially preventable cases of cancer. Ultraviolet light (mostly from the sun) contributes to 83,000 cancers (not including non-melanoma skin cancers), and physical inactivity contributes to 55,000 cases of cancer a year. Second-hand smoke contributes to over 6,000 cases of lung cancer annually.

Modifiable risk factors contributed to a substantial portion of many types of cancer in this analysis, including:

  • Tobacco: lung (84%), larynx (58%), pharynx (52%) and nasal (50%)
  • Excess weight: uterine (43%)
  • Ultraviolet radiation: Melanoma (92%)
  • HPV: human papillomavirus (100%), anal (94%)

Other notable findings:

  • 31,000 cases of breast cancer (11%) were associated with excess weight
  • 24,000 cases of oral, esophageal, pharynx and larynx cancer were associated with low fruit and vegetable consumption (about 30% of each cancer)
  • About 96,000 cases of colorectal cancer (two-thirds of all cases) were associated with a potentially modifiable risk factor

Implications for employers:

  • Promoting tobacco cessation remains a cornerstone of employee health. Employers can encourage smoking cessation programs, and are required to offer these without cost sharing. Many smokers need multiple attempts to successfully quit, and most smokers want to quit. The National Comprehensive Cancer Center recommends offering those who want to quit effective drug therapy (nicotine or varenicline [Chantix]) and multiple counseling sessions.
  • For companies with employees that are mostly sedentary (i.e., sitting at a desk), employers can encourage walking meetings or other ways to have employees stretch and move throughout their day.
  • Over time, more use of effective GLP-1s is likely to lower the rates of some cancers, although that will take time and depend on coverage and unit cost.
  • Alcohol causes a striking amount of cancer and can also be associated with concerning workplace behaviors, so employers should be cautious about alcohol at work-related events.
  • Better nutrition lowers the risk of cancer, and employers that have on-site cafeterias or even vending machines can promote healthy food.
  • Cancer is multifactorial. Although many cases of cancer are caused by potentially modifiable risks, we must avoid blaming those who are unfortunate enough to get cancer.

Few with opioid use disorder are given medication therapy

Although deaths from drug overdoses declined slightly in 2023, few people with opioid use disorder (OUD) are treated with effective medications to treat their addiction. Treatment with buprenorphine (such as Suboxone) or methadone decreases the urge to use illicit drugs and decreases the likelihood of death by as much as 59%.

Nonetheless, only a quarter of those who’d benefit from such treatment received Medication Assisted Treatment (MAT). Those who are seen in an emergency department after treatment with naloxone for a narcotic overdose are at an especially high risk of death if they aren’t treated medically.

Data from the Centers for Disease Control and Prevention shows that Black and Hispanic people, who face larger risks of death from overdose, were less likely to receive MAT.

In a separate study, researchers reviewed data from Massachusetts from 2021–23 on 8,679 individuals who were treated for serious injection-related infections from illegal drugs. Less than half (49%) received MAT within 12 months. Another study from Massachusetts showed that 28% of those on commercial health insurance in 2014 who were newly diagnosed with an opioid use disorder had changed insurance within the year after a diagnosis. Insurance instability can lead to disruptions in medication-assisted therapy.

Implications for employers:

  • There’s a large opportunity to improve the lives of those with opioid use disorder by making medication-assisted therapy (MAT) available.
  • Employers can be sure that their network of providers to treat OUD is adequate, and that members can receive care promptly. Many carriers and vendors have added virtual substance use disorder treatment providers to their networks to support this need. Virtual prescribing of suboxone is under review and may sunset as of December 31, 2024, which could decrease access to MAT. It’s important for employers to be aware of legislation and regulations that may impact their employees’ access to care.
  • Opioid use disorder is common in the commercially insured population. Making naloxone (Narcan) available in the workplace can save lives, and local emergency personnel can provide training to employers if desired.
  • Shatterproof.org is a non-profit dedicated to ending the devastation of the opioid use epidemic. The website is free and provides search options for substance use disorder treatment and can be promoted by employers.

Author


Managing Director and Population Health Leader

Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.

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