Hidden Healthcare Crisis: Healthcare Dollars Buy Patient Harm

Everyone in America has felt the effects of uncoordinated healthcare, from the hassle of medical records lost between providers to devastating stories of medical errors that caused patient harm or a loss of life, uncoordinated care in medicine leaves no one behind. Uncoordinated care in the US directly contributes to out-of-control healthcare costs by adding roughly $340 billion annually in wasted resources – surpassing heart disease or cancer. People’s pockets are squeezed as almost $1 out of every $5 spent in the country goes toward healthcare, yet, the US ranks worst on outcomes for the money. Systemic issues and inefficiencies are stuck in a loop, continuously driving up unsustainable costs and hurting patients. Policy-driven budget cuts miss that healthcare operates in silos, not in an integrated environment. Policymakers and healthcare leaders must focus more on solving the sleeping giant of uncoordinated care by tapping the power of technology.

Coming from both the payer and provider side, I’ve witnessed rampant uncoordinated care, subsequent exorbitant costs and patient harm my entire career. My grandfather was a victim when he was prescribed four different Prednisone prescriptions by several providers. It burned out his adrenals and nearly cost him his life. Unfortunately, this story is not unusual.

Couple patient harm with healthcare spending that continues to surge, increasing by 5.4 percent annually and projected to reach $6.2 trillion by 2028. Aging Baby Boomers (73 million) are placing unprecedented demands on the system. Rising cancer rates among younger people are adding to this burden and heavy emotional toll. Multiple chronic conditions are becoming the norm, driving the prevalence of big-ticket medical treatments. Major insurers face declining earnings while costs outpace inflation. Average Americans and their health plans will never keep up unless we take a significant bite out of spending.

A Financial Hemorrhage 

Estimates show 25-30 percent of total healthcare spending is unnecessary, much of which is due to uncoordinated care. This is fueled by redundant tests, medication errors, missed or delayed diagnoses, lost opportunities for critical interventions, preventable emergency room visits and hospitalizations, difficult transitions from hospital to home, psychological stress from navigating complex systems, and, ultimately, poor patient outcomes. 

Redundant testing costs the healthcare system billions each year, and patients with the most fragmented care undergo roughly twice as many radiology and other diagnostic tests as patients with the least. Patients with one or two chronic conditions and highly fragmented care are 13 percent more likely to visit the emergency department and 14 percent more likely to be hospitalized. 

For instance, an elderly person with congestive heart failure was discharged from the hospital with an increased diuretic dose to manage fluid overload. However, his home health team only received the initial medication list from the time of referral and was never updated when prescriptions were changed before hospital discharge. They followed the outdated regimen since they could not access the hospital’s EHR. His fluid retention worsened, leading to shortness of breath and an avoidable rehospitalization.

Extensive Patient Harm 

Medical errors now rank as the third leading cause of death in the United States, and can often be traced back to breakdowns in care coordination.Nearly 70 percent of avoidable adverse patient outcomes in the US by cost can be attributed to provider behavior, and it’s estimated that 27 percent of medical malpractice is the result of communication failures. 

For example, a diabetic person was hospitalized for an infected foot ulcer. He was given IV antibiotics, and then discharged with oral antibiotics and instructions to follow up with his primary care doctor; however, the hospital sent the discharge summary to a doctor he had not seen in years. The infection worsened, yet, the person assumed antibiotics were enough. By the time he returned to the hospital, the infection required an amputation. This outcome could have been prevented with contextual, real-time alerts ensuring the right physician was notified.

Fundamental, Yet Fixable, Problems with Technology

The fragmented nature of healthcare is here to stay; more than a third of Medicare beneficiaries see five or more physicians. The core issue to fix is the breakdown in communication between clinical and non-clinical providers, driven by the lack of interoperability between health data systems, disjointed workflows, and limited access to timely, necessary patient information.  

Doctors must have access to life-saving information at critical moments. Yet, 34 percent of primary care physicians report that they do not always or most of the time receive useful information from specialists about referred patients. Licensed, experienced providers waste precious hours hunting with fax machines and phone calls. Siloed medical records and limited interoperability hinder real-time, informed treatment decisions, strong care plans followed across the continuum, efficient operations, and harm avoidance.

Providers and health plans must tap technologies to better communicate, easily share and access real-time patient information, and implement cohesive plans. Care coordination platforms, AI-powered tools, and automation are turning the tide. Companies must continue to develop them, and health plans and providers must commit to adopting them. 

Critically, technology solutions must be accessible to all shapes and sizes, not just health systems with flush resources; otherwise, gaps will persist. Clinical and non-clinical providers, both urban and rural including hospitals, physician practices, skilled nursing facilities, home health agencies, long-term care, mental health services, hospice, emergency medical services, and community organizations, must be seamlessly connected to make sure no patient falls through the cracks. 

Out-of-control spending is the preeminent problem in healthcare, that’s true, and largely ignoring one of the biggest causes of waste and patient harm – uncoordinated care –  is not the right or sustainable course of action. Hundreds of billions of dollars and people’s lives are on the line.

About Effie Carlson

Effie Carlson is the CEO of Watershed Health. She brings more than 16 years experience in healthcare leadership, policy, strategy, and business development across the provider and payer sectors, and her experience spans managed care, healthcare technology, government relations, and value-based care. Carlson founded EJC Consulting Group and has served in executive leadership positions at Modivcare, PayrHealth, Team Select, and CareCentrix. Carlson is an active advisor and board member for healthcare organizations, including the Texas e-Health Alliance, SendaRide, and the Non-Emergency Medical Transportation Accreditation Commission® (NEMTAC®).