Published on 13 May 2013
Health Care Spending and Hypertension: The Cost of High Blood Pressure

Hypertension, or high blood pressure, is related to several major chronic diseases. Obesity and diabetes raise your chance of developing high blood pressure, which in turn makes you more likely to suffer from heart disease and stroke. High blood pressure also becomes more prevalent with age.

Those factors make high blood pressure a topic of interest for Medicare, Medicaid, Medicare Advantage plans, and other private health plans. Health insurers and providers increasingly are focusing their efforts to reduce health care costs for people with chronic conditions, who account for a large portion of health costs and spending. The Centers for Medicare and Medicaid Services (CMS) estimates Medicare beneficiaries with two or more chronic conditions accounted for 93 percent of Medicare spending in 2011, or about $276 billion.  Several million of those newly insured under the Affordable Care Act (ACA) starting in 2014 likely have undiagnosed, untreated, or poorly managed hypertension.

Health information technology (HIT), electronic health records (EHR), and health data are vital to identifying which treatments are most effective. Payors increasingly are keeping track of chronic disease care data to evaluate physicians and hospitals, incorporating those metrics into payment reforms and policy changes. CMS, for example, recently launched a data dashboard tool to help researchers, physicians, and policymakers gather information about how to increase the quality and reduce the cost of care. Health IT also facilitates chronic care management and patient engagement, through remote patient monitoring, e-prescribing, and telehealth.

Hypertension Care Expenditures Reach $42.9 billion:

The Agency for Healthcare Research and Quality (AHRQ) has long gathered extensive data on health costs and spending. AHRQ frequently produces statistical briefs using data from the Medical Expenditure Panel Survey (MEPS). Subjects for recent briefs include avoidable hospitalizations among seniors in nursing homes, health care associated infections in hospitals, and expenditures on common conditions among young women.

Hypertension is the focus of the latest AHRQ statistical brief, and is a good resource to inform health policy for chronic conditions. An overview of the findings:

  • In 2010, about 58.6 million persons or 25.1 percent of adults age 18 and older were treated for hypertension.
  • Direct health care spending to treat hypertension totaled $42.9 billion in 2010, with almost half ($20.4 billion) in the form of prescription drugs.
  • Annual expenditures for those treated for hypertension averaged $733 per adult in 2010.
  • The mean expenditure per person for the treatment of hypertension was higher for Hispanics and non-Hispanic blacks ($981 and $887, respectively), than for non-Hispanic whites ($679) and non-Hispanic others ($661).

Read the full brief here.

Research on Hypertension:

Health Affairs is another good resource for research about the effects of high blood pressure on chronic disease, health costs, prescription drug benefits, employee health care, and health care policy in general. Below are several abstracts for Health Affairs articles on the subject.

Mobile Clinic In Massachusetts Associated With Cost Savings From Lowering Blood Pressure And Emergency Department Use

By Zirui Song, Caterina Hill, Jennifer Bennet, Anthony Vavasis, and Nancy E. Oriol

Mobile health clinics are in increasingly wide use, but evidence of their clinical impact or cost-effectiveness is limited. Using a unique data set of 5,900 patients who made a total of 10,509 visits in 2010–12 to the Family Van, an urban mobile health clinic in Massachusetts, we examined the effect of screenings and counseling provided by the clinic on blood pressure. Patients who presented with high blood pressure during their initial visit experienced average reductions of 10.7 mmHg and 6.2 mmHg in systolic and diastolic blood pressure, respectively, during their follow-up visits. These changes were associated with 32.2 percent and 44.6 percent reductions in the relative risk of myocardial infarction and stroke, respectively, which we converted into savings using estimates of the incidence and costs of these conditions over thirty months. The savings from this reduction in blood pressure and patient-reported avoided emergency department visits produced a positive lower bound for the clinic’s return on investment of 1.3. All other services of the clinic—those aimed at diabetes, obesity, and maternal health, for example—were excluded from this lower-bound estimate. Policy makers should consider mobile clinics as a delivery model for underserved communities with poor health status and high use of emergency departments.

Hypertension, Diabetes, And Elevated Cholesterol Among Insured And Uninsured U.S. Adults

By Andrew P. Wilper, Steffie Woolhandler, Karen E. Lasser, Danny McCormick, David H. Bor, and David U. Himmelstein

In this paper we explore whether uninsured Americans with three chronic conditions were less likely than the insured to be aware of their illness or to have it controlled. Among those with diabetes and elevated cholesterol, the uninsured were more often undiagnosed. Among hypertensives and people with elevated cholesterol, the uninsured more often had uncontrolled conditions. Undiagnosed and uncontrolled chronic illness, which is common among insured people, is even more frequent among the uninsured.

How Cumulative Risks Warrant A Shift In Our Approach To Racial Health Disparities: The Case Of Lead, Stress, And Hypertension

By Margaret Hicken, Richard Gragg, and Howard Hu

Blacks have persistently higher rates of high blood pressure, or hypertension, compared to whites, resulting in higher health costs and mortality rates. Recent research has shown that social and environmental factors—such as high levels of stress and exposure to lead—may explain racial disparities in hypertension. Based on these findings, we recommend a fundamental shift in approaches to health disparities to focus on these sorts of cumulative risks and health effects. Federal and state agencies and research institutions should develop strategic plans to learn more about these connections and apply the broader findings to policies to reduce health disparities.

Drug coverage and drug purchases by Medicare beneficiaries with hypertension

By J Blustein

Research has shown that older Americans with prescription drug coverage purchase more medications; however, it is unclear whether they are more likely to purchase essential medications. This study addresses that question by examining the relationship between drug coverage and medication purchases among older Americans with hypertension. It finds that drug coverage has a significant impact: It lowers the likelihood that persons with hypertension will go without antihypertensive drugs, and it raises the number of tablets purchased among those who purchase these essential drugs.

Wellness Incentives In The Workplace: Cost Savings Through Cost Shifting To Unhealthy Workers

By Jill R. Horwitz, Brenna D. Kelly, and John E. DiNardo

The Affordable Care Act encourages workplace wellness programs, chiefly by promoting programs that reward employees for changing health-related behavior or improving measurable health outcomes. Recognizing the risk that unhealthy employees might be punished rather than helped by such programs, the act also forbids health-based discrimination. We reviewed results of randomized controlled trials and identified challenges for workplace wellness programs to function as the act intends. For example, research results raise doubts that employees with health risk factors, such as obesity and tobacco use, spend more on medical care than others. Such groups may not be especially promising targets for financial incentives meant to save costs through health improvement. Although there may be other valid reasons, beyond lowering costs, to institute workplace wellness programs, we found little evidence that such programs can easily save costs through health improvement without being discriminatory. Our evidence suggests that savings to employers may come from cost shifting, with the most vulnerable employees—those from lower socioeconomic strata with the most health risks—probably bearing greater costs that in effect subsidize their healthier colleagues.

About Author

An expert on Medicaid, Medicare, and health reform, Kip Piper, MA, FACHE, is a consultant, speaker, and author. Kip Piper advises health plans, hospitals and health systems, states, and pharma, biotech, medical device, HIT, and investment firms. With 30 years’ experience, Kip is a senior consultant with Sellers Dorsey, top specialists in Medicaid and health reform. He is also a senior advisor with Fleishman-Hillard and TogoRun. For more, visit KipPiper.com. Follow on Twitter @KipPiper, Google +, Facebook and connect on LinkedIn.

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