Benefits and Compensation, Learning & Development

An Employer’s Role in Sepsis Prevention

Sepsis, a life-threatening condition stemming from the body’s response to infection, is a growing concern not only in the United States, but also worldwide. By exploring the disturbing statistics surrounding sepsis, its economic impact, the challenge of antimicrobial resistance and the potential of AI-driven solutions, we can recognize the critical role employers and comprehensive benefits can play in both preventing and treating this condition.

Alarming Statistics: Unveiling the Harsh Reality of Sepsis

The staggering statistics released by Sepsis Alliance paint a grim picture of this potentially fatal medical condition, affecting diverse segments of the population. More than 1.7 million people are diagnosed with sepsis each year, equivalent to a new diagnosis occurring every 20 seconds. Alarmingly, 75,000 children experience sepsis annually, leading to approximately 7,000 fatalities. It’s a harrowing fact that more children die from sepsis than from pediatric cancer—an issue often overshadowed in public discourse. Additionally, sepsis is responsible for an astounding 261,000 maternal deaths, solidifying its role as a significant factor in pregnancy-related mortality rates in the United States. It also disproportionately affects the Black community, with individuals from this group nearly twice as likely to die from sepsis. This alarming statistic points towards potential healthcare access disparities.

Beyond the physical toll, sepsis imposes a substantial economic burden. According to QBE North America’s 2023 Accident and Health Market Report, sepsis accounts for three to four percent of all stop-loss claims for QBE North America. Remarkably, it stands as one of the driving factors of high‑cost hospitalizations in the United States, with average costs for an inpatient sepsis admission double the average cost per inpatient stay across all other conditions. Additionally, sepsis is the number one cause of readmission to the hospital, with costs averaging more than $3.5B every year. The scale of this issue is significant and demands attention.

The Economic Burden of Sepsis

The financial toll of sepsis is considerable on patients as well as the overall healthcare system. Annual costs attributed to acute sepsis hospitalization and skilled nursing care have been estimated at a staggering $62 billion, underscoring the immense economic impact of this condition. Even after discharge, challenges persist as sepsis remains the leading cause of hospital readmissions. These readmissions translate into annual costs exceeding $3.5 billion, adding to the overall burden on healthcare systems.

The challenge of antimicrobial resistance (AMR) further compounds the complexities of sepsis, contributing to higher mortality rates and greater economic burden due to the prolonged and complex critical care required to treat resistant infections. AMR, characterized by infections resistant to antibiotics, presents a formidable hurdle as infections that were once manageable, now pose greater risks due to dwindling treatment options—making timely interventions even more challenging.

AI is Revolutionizing Sepsis Diagnosis: A Beacon of Hope

The emergence of Artificial Intelligence (AI) holds promise in the realm of sepsis diagnosis and timely intervention. A notable example is the Targeted Real-Time Early Warning System, developed by Johns Hopkins. This system leverages machine learning to monitor patients’ trajectories from admission to discharge. By analyzing medical history, current symptoms and lab results, the system promptly identifies sepsis risks promptly and recommends treatment protocols, including timely administration of antibiotics. In a groundbreaking development, this AI tool demonstrated a remarkable accuracy rate of nearly 40% in 82% of sepsis cases, a substantial improvement over prior diagnostic tools that often registered accuracy rates as low as 2-5%. Perhaps the most compelling aspect is its ability to detect sepsis nearly six hours earlier than traditional methods, a timeframe where swift intervention can prove to be the difference between life and death.

As the field of AI-driven sepsis treatment continues to evolve, clinical trials offer potential solutions. A beacon of hope lies in the NeoSep1 clinical trial, initiated in 2023. This trial aims to assess new antibiotic combinations for sepsis treatment in vulnerable newborns, who are disproportionately affected by its devastating effects. Given that sepsis impacts up to 3 million newborns globally each year and a significant percentage of pathogens have developed antibiotic resistance over the past decade, the urgency is undeniable.

An Employer’s Role in Prevention

Employers can play a crucial role in sepsis prevention, extending beyond medical realms to workplace environments. For instance, creating clean workspaces and fostering an atmosphere that encourages sick employees to stay home play essential roles in mitigating the spread of infections like sepsis. Employers can promote habits that safeguard employee health, including adequate ventilation and frequent handwashing.

Comprehensive benefits can also play a pivotal role in early detection and prevention. Offering low or no co-pays for primary care visits and preventive screenings encourages employees to seek medical attention promptly, facilitating timely interventions. Benefits supporting the management of chronic conditions and promoting healthy lifestyles significantly contribute to sepsis prevention.

Challenges in Underwriting and the Road Ahead

The underwriting process faces complexities when assessing sepsis-related risks. Accurate underwriting necessitates evaluating factors, such as current claims, patient prognosis and potential post-acute care needs. With emerging treatments on the horizon, the attention shifts towards benefits accommodating evolving medical interventions. Adapting benefits to incorporate enhanced coverage for “hospitals without walls” care models – such as those providing services such as physician home visits, home healthcare services, outpatient services, telemedicine and remote patient monitoring – ensures that individuals receive the necessary care even beyond traditional hospital settings.

The Bottom Line

Sepsis remains a formidable challenge, yet by understanding statistics, economic ramifications, the potential of AI and the proactive roles of employers and comprehensive benefits, pathways for improved outcomes emerge. Harnessing the potential of AI-driven diagnostics and progressive treatment options, as well as fostering prevention strategies, enables collective efforts to combat sepsis and enhance the lives of countless individuals.

Cheryl Levesque, VP Medical Risk Underwriting for QBE North America’s Accident & Health business, leads a team of consultants who perform risk management assessments and case management oversight to QBE’s medical stop loss and captive clients nationwide. Cheryl joined QBE in 2011 as a Lead Risk Management Consultant. In this role, she managed cost containment initiatives as well as new Accident & Health revenue streams, such as captive stop loss and organ transplant. Cheryl was nominated as a QBE Top 10 Employee in both 2014 and 2017, becoming a global finalist in 2017. Prior to QBE, she worked as a transplant and oncology case manager at Optum and as a Risk Management Nurse for a medical stop loss provider.
She holds a Bachelor of Science in Nursing from Salem State College and a Master of Science in Management with a concentration in Healthcare Administration from Lesley University.

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