Rising health care costs and quality of care concerns require a re-evaluation of various aspects of health care delivery. In order to properly manage costs, payers need to understand how different patient populations contribute to spending trends and where suboptimal quality of care is more prevalent, and, therefore, may drive cost trends.
To demonstrate significant opportunities for improvement in the management of postmenopausal women by highlighting areas of imbalance between health care costs and quality of care.
Women tend to use significantly more services and spend more health care dollars than men. The greatest disparity in health care spending between men and women has been noted in the population aged 45 to 64 years. In this age group, women's health issues primarily revolve around chronic conditions and menopausal symptoms. With the onset of menopause, the risk of cardiovascular disease (CVD), breast cancer, and osteoporosis increases significantly. However, substantial evidence indicates that there are broad gaps in the quality of care received by postmenopausal women. In some populations, breast cancer screening rates are almost 20% below the national target. Stratification of health plan performance with the National Committee for Quality Assurance/Health Care Effectiveness Data and Information Set (NCQA/HEDIS) measures related to CVD demonstrates gender-based gaps, even when there are no disparities in access to care. The widest gender gap in CVD management is observed with low-density lipoprotein (LDL) cholesterol control rates. In the management of postmenopausal women with a history of fractures, standards of care are met only 19% to 50% of the time. After the age of 45, the majority of women either do not receive any information about menopause from their physicians or they are unsatisfied with the menopause counseling that they do receive. These quality gaps should be considered in light of the high prevalence of chronic illness and costs attributed to these conditions and menopausal symptoms in women.
When reviewing strategies for reducing health care costs, managed care organizations (MCOs) should focus on the management of postmenopausal women. With the use of proper screening, preventive care, and therapeutic management in postmenopausal women, an MCO could potentially achieve downstream reduction in overall costs for this population.
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