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The flu epidemic is taking a toll on the U.S. healthcare system. Here's how health insurers can curtail spending on flu care.
In addition to starting earlier, this season’s influenza is also remarkable for spreading throughout the United States relatively quickly-with all the continental U.S. states reporting widespread flu activity concurrently for the first time.
Since January 1, the CDC has estimated that more than 5% of all doctor’s visits are attributable to influenza-like illnesses-which is consistent with moderately severe flu activity, says Mark Gallivan, MPH, senior data scientist, Metabiota, an epidemic risk analytics company in San Francisco. Flu hospitalizations have also spiked and reported deaths are consistent with the start of a moderate to severe season.
Influenza is a serious disease that circulates annually in the United States, resulting in widespread illness. The CDC estimates that influenza-associated deaths in the United States ranged from a low of 12,000 (during 2011 to 2012) to a high of 56,000 (during 2012 to 2013). The influenza vaccine is recalibrated annually to try and match the anticipated strain, Patrick Ayscue, DVM, director of epidemiology, Metabiota, says. This year, the match is only moderately effective.
This year’s flu season is bad largely due to the predominant circulating strain (H3N2) of influenza, Gallivan says. Every flu season viruses mutate, and new strains dominate (e.g., H3N2 and H1N1). One strain may be bad in one year, but nearly disappear the next one. Over the past few influenza seasons, the H3N2 strain has not been as widespread. However, H3N2 flu seasons generally hit harder than other flu strains (H1N1) especially among the elderly. Furthermore, because the elderly are more likely to suffer complications resulting from the flu, H3N2 flu seasons can cause more doctor visits, more hospitalizations, and even more deaths than non-H3N2 flu seasons.
Once sick with the flu, a person is at increased risk of developing a secondary viral or bacterial infection-which is a significant cause of death among the elderly, Gallivan says. This is particularly true if you have underlying medical conditions including a weakened immune system or respiratory syndrome. Additionally, if hospitalized with the flu, there are increased risks of hospital-acquired infections (e.g., Clostridium difficile, staph infections).
Healthcare spending is impacted with even a mild flu season, resulting in a substantial increase, Gallivan says. For the most recent flu season with available data (2015 to 2016) flu caused 310,000 hospital stays at cost of more than $3.5 billion. The average cost of a hospital stay is approximately $2,200 per person, the Kaiser Family Foundation reports, with an average stay lasting 5.3 days, according to the Agency for Healthcare Research and Quality. In addition, every year the CDC estimates that U.S. workers lose up to 111 million workdays at an estimated loss of $7 billion in sick days and lost productivity because of flu.
How can health insurers curtail spending on flu care?
Shane Speights, DO, dean and associate professor of medicine, NYIT College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR, says a key is to be proactive rather than reactive-which means promoting the flu vaccine. “Insurers should encourage members six months of age or older who don’t have a contraindication to get the flu vaccine,” he says. “Although the vaccine has limited effectiveness in preventing the flu with this season’s current strain, it almost universally decreases the flu’s length and severity for those who get the vaccine. And, depending on the type of vaccine, it can protect against three or four different flu types.”
Another way to reduce spending on flu care is to cover virtual visits. “Many patients now want this type of service, because it’s faster and cheaper for them; there is no reason why patients should wait in crowded urgent care or emergency rooms,” Speights says.
Healthcare provider education also needs to be emphasized. “Current CDC guidelines for managing flu patients during epidemics generally do not recommended testing for the flu,” Speights says. “If patients present with symptoms that are consistent with flu, then that is enough to make the diagnosis. Unnecessary tests drive up healthcare costs and don’t change outcomes.”
The medical evidence regarding the use of anti-flu medications is not clear and healthcare providers should understand that CDC recommendations for anti-flu medications are generally only indicated for certain high-risk groups; the true benefit for the general, healthy population is minimal. “However, many providers give patients prescriptions for expensive drugs that can have significant side effects and don’t generally improve their illness,” Speights says.
Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.