Saul Marquez, Host at Outcomes Rocket Podcast

Delivering Cost Transparency and Clinical Efficiency

Monday February 22nd 2021

Delivering Cost Transparency and Clinical Efficiency

Cost transparency blog post Outcomes Rocket


We want healthcare providers to deliver “value-based care.”  Cost is a big part of value, yet most physicians do not know and are not systematically taught the cost of the things they order.  How can they determine “value” if they don’t know what things cost?


Leveraging technology to offer cost-effective and efficient healthcare


IllumiCare is a technology company that developed a workflow management platform that empowers physicians with hospital cost and patient context. Its innovative Smart Ribbon technology is an app-based platform that fits any workflow by hovering over the EMR screen. This platform boasts of a comprehensive suite of apps that providers can use to make better decisions. 


The Smart Ribbon calculates the real-time cost of every clinical order or a test or medicine it receives. It tracks the cost of medications and displays lower cost and dose-equivalent options to providers. It also provides personalized, high-cost clinical variation nudges within the EMR workflow. The Smart Ribbon can be customized according to the health system’s needs, displaying only certain apps based on the user preference. It is also easy to use and does not require any logins. 


llumiCare’s Smart Ribbon has been helping hospitals increase efficiency. In 2016, the company partnered with the Texas Hospital Association, and initial pilots showed a savings of $112 to $202 in direct costs per inpatient admission. The Vizient Southern States reported they have reduced their admission spend by $170. Houston Methodist Sugar Land reported approximately $717,000 savings with a cost reduction of $105 per admission. 


Cost Impact of COVID-19


COVID-19 hit the health industry hard. The direct impact is the increased cost of care of healthcare payers due to the high volume of people requiring tests and treatment. 


IllumiCare gathered data across 10 health systems that cover probably about one hundred and eighty or so hospitals across seven different states that are geographically dispersed. And this data is around forty thousand COVID positive patients hospitalized covid to these are all inpatients


In my interview with G.T. LaBorde, CEO of IllumiCare, he shared some of the cost of the pandemic. He said, “When we look at the subcategories of spending, really a lot of that reduction has come not really in a big reduction of medication cost or in radiology, but it’s mostly been driven by lab cost reduction. In the beginning, we were spending something like$965 per admission, and now that’s down to about $589 dollars in admission. We are getting more efficient both financially as well as kind of clinically in moving these patients kind of through the process.”


Hospitals are getting better at managing the disease, driving down the length of stay for COVID-19 patients. But what about the cost of medication?


G.T. talked about several medications that were previously used, their efficacy, and the cost. 


“So there are three stories I wanted to share with you about medications that are used. one of them is Hydroxychloroquine. It was seen as a common, very cheap drug. It’s not super expensive. It’s pretty cheap because it’s actually a generic drug. Around summertime, that drug wasn’t used at all anymore,” he shared. “Another one that sort of followed that that track, still used quite a decent amount, is a drug called Famotidine. We saw that also sort of spike over the summer. But it’s really kind of waned significantly.”


He continued, “The last one that was really interesting was a super expensive drug called Tocilizumab.  It was the single most expensive drug used to treat COVID patients because it was it cost about two thousand four hundred dollars $2500 per admission to use this drug.”


Those drugs were used without clear data backing them up, but at that time, physicians wanted to save people and those medications provide anecdotal evidence. For medications to be more effective, real-world data in the drug development process should be used. 


In contrast to the first three drugs G.T. mentioned, he also presented dexamethasone, enoxaparin, and Remdesivir. Dexamethasone, according to G.T., is a corticosteroid. 64% of COVID positive patients receive dexamethasone and its average cost is $5.20 per admission. Enoxaparin an anti-clotting drug that costs about $128 on admission, making it relatively cheap and with demonstrated efficacy.  


Remdesivir got a lot of press. When studied, it showed efficacious so 23% of COVID positive patients were given this drug. 


But there’s a catch. 


G.T. explained that currently, the drug does not cost anything. “Right now, when we look at our data set, the cost is a big fat zero. It’s free. It’s because its manufacturer, Gilead, has given away a million doses.”


That’s good news, but eventually, that drug will run out. And when that happens, hospitals and insurers have to pay $3,120 per five-day treatment course. 


“If we start giving 23%  of the patients with COVID a drug that costs $3,120 on top of all of the other care and drugs and things that we use, it’s going to definitely drive up the price of an average COVID emission,” G.T. concluded. 


Knowing the efficacy and cost of different drugs helps doctors prescribe the best one for the patient’s needs. With IllumiCare, you can drive down costs and deliver the value-based care patients are looking for. 


Check out my full interview with G.T. LaBorde here:


Written By

Saul Marquez

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