How Simple Behavioral Changes Can Save $163 Billion a Year in Health Care Costs

By Steve Miller, MD, Chief Medical Officer, and Bob Nease, Ph.D, Chief Scientist of Express Scripts, Inc.

Although the health care bill sparked long, heated, and continuing debate over the role of government, new research shows that, when it comes to reducing waste in our system and improving our health outcomes, the most important reforms begin in the home.

The first study to quantify the hidden pharmaceutical costs of traits like forgetfulness, procrastination and how we take our medications, estimates the annual tab for these very human behaviors at $163 billion. With conservative estimates for inflation, this waste would total more than $2 trillion when projected over 10 years.

We've all become numb to numbers during this long debate, so let's pause to consider that staggering sum. You may recall that a tipping point in the healthcare debate was reached when the non-partisan Congressional Budget Office completed its scoring of the final bill and concluded that it would reduce the federal deficit by $143 billion over 10 years.

The deficit-reduction number, although significant, is just one 14th of the amount of waste we can eliminate by optimizing behaviors related to prescription drugs. Put another way, we can offset the entire 10-year, $940 billion cost of the legislation in just five years if we all take action and make better choices in the pharmacy area alone.

Three simple behaviors can achieve these savings. Adhering to the prescribed drug therapy (thereby avoiding the medical expenses associated with non-adherence) can save $106 billion a year. Choosing the more cost-effective drug, including lower-cost brand and generic alternatives, when appropriate for the therapy, can save $51 billion a year. Finally, identifying the most appropriate channel for delivery of the drug to the patient (mail order, for example) can save $6 billion a year.

Not exactly unbiased. Very hard to tell how much opinion and how much fact.





The best argument here isn’t financial. Avoiding the suffering seems a much better and direct incentive. Who enjoys being sick?

When my diabetic mother was prescribed 11 different medications following heart surgery and stroke, Kerr Drugs (one of the local drug stores) worked with us to have Mom's meds pre-packaged and sent to her home. It was very convenient, much quicker, and safer for her. We didn't have to worry that a prescription was going to run out and somebody better get to the drugstore to pick up the refill.

Adhering to the prescribed drug therapy is indeed important. We found that my late father-in-law had not been taking his heart medication as prescribed, which may have contributed to his death. We had tried to get him to arrange to have his meds pre-packaged and sent to his home the same way we did with my mother. He refused. He also removed the Life-Line system we had installed for him, saying that "nothing was going to happen to him." (He pocketed the refund! ) Had he had that Life-Line device around his neck or on his wrist when he had the heart attack that killed him, he might have been saved. Being stubborn and obstinate does little to contribute to good health.

Mom was on Medicare and she had a NC Blue Cross-Blue Shield supplementary insurance policy. The pharmacist at the drugstore told us about the pre-packaged meds option and we did not hesitate to sign Mom up for it. I think we paid $15 a month for the service....or something like that. Before, Dad had always put Mom's meds into a pill case, similar to yours, and doled them out to her. But after he died, Mom's daily caregiver, my sister, brother, and I took over that responsibility, but it had to be written down who had given what to Mom. My two siblings and I were sharing her nighttime care. My brother, especially, was careless about writing things down. The pre-packaged meds took care of that problem.

If you can do your own medicating, it helps, like you do. Mom took care of her insulin injections and would have been ok with all the pills because she knew what she had to take, but she couldn't be relied on to take the meds on time and how much. Like you, she also took aspirin. I will always believe that if my mother had not fallen and broken a hip, she would be alive today. She was doing ok until that happened, although there was some evidence of short term memory loss.