Not every dollar invested in healthcare goes toward making someone better. Waste and fraud are just two factors contributing to rising healthcare costs in the US.

A team from Thomson Reuters presented on the topic of "Detecting, Eliminating Waste and Fraud in Government Programs." The group outlined and discussed 5 strategies to control cost, improve quality and increase access to healthcare. Here are the five strategies suggested by Thomson Reuters.

Reducing Wasteful Healthcare Spending: A How-To Guide

• Without efforts to control healthcare expenditures, US system waste could reach $1.6 trillion by 2020- doubling in just 10 years.
• Reasons for implementing a culture of health- healthcare costs are rising- 16% of GDP and rising.
• Employee insurance costs rose 7.3% in 2009.
• Substantial monetary and productivity losses due to health issues.
• NEHI defines waste as “Healthcare spending that can be eliminated without reducing the quality of care.”
• 1/3 healthcare dollars spent doesn’t go to making someone better.

Should these be considered waste?

• Increased disease due to modifiable behaviors- many conditions can be avoided by adopting healthier lifestyles.
  • Is the system responsible for reducing these excess costs.
• High price of medical services- US charges higher prices than other countries for services such as specialist procedures, hospital stays and prescription drugs.

Reasonable Goal

• New England Journal of Medicine
• If reducing wasteful healthcare spending was phased- starting at 5% per year and increasing by 5% over the next 10 years, $3.6 trillion would be saved.

RELATED: What is Medicare Part D Fraud?

Targets for Reducing Waste

Fraud and Abuse

• Suggested target reduction- 15% in 5 years, 60% in 10 years.
• Challenges: They payer and receiver of the services are separate.
• Fraudsters are very skilled at manipulating the system.
• Healthcare professionals minimize the extent of fraud, claiming it’s only among non-professionals.
• Payers don’t want to jeopardize their relationships with clients.

5 Strategies for Reducing Wasteful Healthcare Spending

1. Consumer Activism and Transparency

• Encourage patients and consumer to become actively involved in their own care. Educate and engage them on the value and risks of specific treatment options.
• Eliminate disincentives for more conservative treatment options.

2. Systems Improvements and Care Coordination

• Better link providers in actual or virtual teams. Make all relevant information available at point of care.
• Reduce fragmentation in the delivery of care.
• Improve care coordination and eliminate redundancy- send information back to primary providers, if available, to make their records complete.

3.  Patient Safety and Quality Improvement

• Set industry goals- Learn from mistakes, Six Sigma.
• Encourage and support quality improvement initiatives to reduce healthcare treatment errors.

4. The Medical Home and Culture of Health

• Ensure that patients are actively engaged, along with their clinicians, in managing their own health.
• Promote healthy workplaces and environments that make wellness a priority.

5. Payment Integrity/Fraud and Abuse

• Engage the community in programs that simplify the billing process while eliminating opportunities for fraud and abuse.
• Educate public and provider community impact of fraud on available resources.
• Recognize providers for high levels of payment integrity- reward for best practices.

RELATED: The Ultimate Guide to US Healthcare Fraud Schemes

Key Algorithms

• A list of ways to identify fraud, such as distance between beneficiary address and provider location, submissions including a large number of high-intensity codes, services after the death of a patient and overuse of specific combinations of medical codes.
• Algorithm identified $60 million in ambulance trips to nowhere- one state alone in the US.
• Put drug seekers and “doctor shoppers” into lock in programs.
• Geographic distance- obviously patients are likely to travel for major procedures (Mayo Clinic, Pediatric Oncology, etc.) but they shouldn’t need to travel those distances for basic checkups and such.