Robert Weiss
Lymphedema Patient Treatment Advocate, USA
Title: Cost of a lymphedema treatment mandate - 16 years of experience in the commonwealth of virginia
Biography
Biography: Robert Weiss
Abstract
Statement of the Problem. Treatment of chronic illness accounts for over 90% of Medicare spending. Chronic lymphedema places over 3 million Americans at risk of recurrent cellulitis. Health insurers and legislators have taken an active role in fighting attempts to mandate the treatment of lymphedema for fear that provision of the physical therapy and compression materials would result in large and uncontrollable claim costs. Published studies compare cost of treatment versus cost of non-treatment for a select group of lymphedema patients. They do not provide the data necessary for insurance underwriters’ estimations of expected claim costs for a larger general population with a range of severities, or for legislators’ evaluations of the costs of proposed mandates to cover treatment of lymphedema.
Methodology. The Commonwealth of Virginia has had a lymphedema treatment mandate since 2004. Reported data for 2004–2019, representing 80% of the Virginia healthcare insurance market, contains claims and utilization data and claims-based estimates of the premium impact of its lymphedema mandate.
Findings. The average actual annual lymphedema claim cost was $2.03 per individual contract and $3.54 per group contract for the years reported, representing 0.05 and 0.08 % of average total claims. The estimated premium impact ranged 0.16–0.32% of total average premium for all mandated coverage contracts. Office visits decreased 6.49% and hospitalizations decreased 16.47% over the 16-year period.
Conclusions. Ten years of insurance experience with a lymphedema treatment mandate in Virginia shows that costs of lymphedema treatment are an insignificant part of insured healthcare costs, and that treatment of lymphedema reduces costs of office visits and hospitalizations due to lymphedema and lymphedema-related cellulitis. Lymphedema treatment is a potent tool for reduction in healthcare costs while improving the quality of care for cancer survivors and others suffering with this chronic progressive condition.