chronically ill

MN physician group calls for P4P standardization

Tue, 20 Nov 2007 06:59:57 -0500

The Minnesota Medical Association (MMA) has come out with a new report taking an increasingly popular position--that health plans should standardize quality measures before they continue rolling out pay-for-performance programs. The report, which looked at the state's nine pay-for-performance programs, notes that since different plans set different criteria--such as the age range for required annual mammograms--P4P is tying them up in knots administratively. MMA also notes that some P4P programs don't adjust for age, medical risk or demographic differences between patients.

In the report, MMA urges health plans to adopt not only a single set of quality measures which adjust for risk, but also a streamlined data collection process which makes it easier to comply with measurement efforts. They're also asking plans to provide more incentives for coordinating the care of chronically-ill patients and for investing in health IT. In addition, they're suggesting that P4P plans shouldn't penalize doctors for recommending brand name prescriptions over generics. (Good luck with that one, guys.)

To learn more about the group's analysis:
- read the MMA press release
- read the MMA report (.pdf)
- read this Minneapolis/St. Paul Business Journal article

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Louisiana healthcare shaped by market more than patients

Wed, 14 Nov 2007 06:59:54 -0500

A new report by a state researcher concludes that medical care in Louisiana is being shaped to a large degree by market forces, such as the number of hospital beds available in a region. The researcher, David Wennberg, concluded that physicians were prescribing unnecessary treatments for chronically-ill patients, seemingly in response to external factors such as the supply of hospital beds, equipment and specialists available. He drew these conclusions after studying Medicare, Medicaid and private insurance data for the state.

Wennberg's findings come as part of a larger effort by state officials and private groups to boost Louisiana's low population health rankings. One new group, dubbed the Louisiana Health Care Quality Forum, plans to use the data Wennberg accessed on an ongoing basis to see whether physicians are following consistent practices in managing chronic illnesses like diabetes and high blood pressure.

Wennberg's report apparently didn't analyze how the market forces impact care in states other than Louisiana, but I'm sure researchers would find similar effects across the U.S. It'd be really interesting to find out how big a role those effects play nationally. Data, anyone?

To find out more about this research:
- read this Times-Picayune article

ALSO NOTED: FDA issues anemia drug warning; Time to improve stroke rehab options; and much more...

Fri, 09 Nov 2007 06:59:50 -0500

> The FDA has issued a warning regarding anemia drug use, suggesting that in cancer patients undergoing chemotherapy, some of these drugs led to tumor growth and decreased survival rates. Article

> These days, it's looking like a new era in stroke treatment--but rehab is still lagging behind. Article

> A new study further supports the notion that telemedicine can offer clinical and cost-savings benefits in caring for chronically-ill patients. FierceHealthIT

> Building a patient-centered care program? Perhaps your IT department can help. FierceHealthIT

And Finally... Oh, for heaven's sake...$24,000 for a concert ticket? Not even if Elvis came back from the dead. Article

Program involves pharmacists in chronic disease care

Tue, 02 Oct 2007 06:59:55 -0400

A new pilot program underway at a string of federally-funded community health centers hopes to improve patient care and lower costs by involving pharmacists in the care of chronically-ill patients. The program's participants include JWCH Clinic at the Weingart Center in Los Angeles, which has had such a program for diabetes for the past two years. Diabetics who participated in the program reduced their blood sugar levels by 3.7 percentage points and reduced blood pressure to almost-normal levels. Another participating facility is El Rio Community Health Center in Tucson, AZ, where participating diabetics had lower blood sugar levels than patients who got standard care. Jimmy Mitchell, Office of Pharmacy Affairs director for the Health Resources and Services Administration, calls the program the "future of the practice of pharmacy."

To find out more about the program:
- read this Kaiser Daily Health Policy Report item

Related Articles:
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PA law will expand nurse-practitioner role

Fri, 20 Jul 2007 06:59:55 -0400

It appears Pennsylvania Gov. Edward G. Rendell (D) will sign a bill today expanding the permitted scope of practice for the state's nurse practitioners. The move is part of a package of changes being pushed by Rendell as part of his health reform agenda for the state. The new law will allow nurse practitioners to perform new functions, including ordering wheelchairs, treating chronically ill patients in their homes and referring patients to specialists like occupational therapists. The new law also will give other professionals new powers; for example, certified midwives will get prescribing powers, and dental hygienists will be allowed to clean teeth without direct dentist supervision.

The director of the Governor's Office of Health Care Reform, Rosemary Greco, says giving nurse practitioners greater freedom will mean some patients face shorter waits for care, as they'll no longer be waiting in line for scarce physician time.

To learn more about the new legislation:
- read this The Philadelphia Inquirer piece

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Study: When uninsured get Medicare, it's costly

Wed, 11 Jul 2007 20:01:34 -0400

A new study suggests that when chronically-ill uninsured adults age into Medicare eligibility, they're sicker than adults who had commercial insurance when they entered Medicare. The study, published in The New England Journal of Medicine, found formerly uninsured adults were hospitalized more often and had greater medical expenses through at least age 72.

The study, conducted by Dr. John Z. Ayanian of Harvard Medical School, looked at 9,760 adults who were 51- to 61-years-old in 1992. It found when uninsured people became eligible for Medicare, they had 13 percent higher levels of doctor visits, 20 percent more hospitalizations and 61 percent greater medical expenditures. The effects were strongest in people with cardiovascular disease and diabetes.

To learn more about the study:
- read this piece in The New York Times

Related Article:
Medicare funds at-home doctor visits for chronically ill. Report

Study: Higher co-pays drop drug use, raise costs

Thu, 05 Jul 2007 20:01:36 -0400

New research suggests that, at least in patients with chronic diseases, raising drug co-pays tends to cut drug use--but also raise the rate of patient hospitalizations and ED visits. The research, conducted by Dana Goldman, director of RAND Health's Bing Center on Health Economics, found that for every 10 percent increase in consumer cost-sharing, pharmacy spending drops 2 to 6 percent. However, in patients with conditions like congestive heart failure, high cholesterol, diabetes and schizophrenia, such pharmacy cost drops are associated with increases in the need for expensive hospital services. The evidence that greater drug cost-sharing raises inpatient and ED costs for the chronically ill was "unambiguous," Goldman said.

To prepare his paper, Goldman studied 132 articles published from 1985 to 2006, analyzing how drug cost-sharing affected drug access, medical spending and health outcomes. The research was published this week in the Journal of the American Medical Association.

To learn more about the study:
- read this United Press International item

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The progressive co-pay. Report

Home care model growing popular

Tue, 15 May 2007 20:01:35 -0400

A California company is quickly becoming one of the leaders in a new--and some say, critically important--care delivery niche. Care Level Management, of Woodland Hills, CA, cares for chronically ill patients in their homes rather than making them come to a physician's office. The idea is to head off potentially serious and expensive complications which would otherwise put them in the hospital. Care Level's primary client is CMS, which is paying Care Level a monthly case stipend and fee per visit for a base of 25,000 Medicare enrollees to run a pilot test on this concept. For the pilot, CMS is targeting the 5 percent of Medicare beneficiaries who generate the greatest costs. In doing this, Care Level is taking a big gamble--it's agreed to return the money unless net patient costs are at least 5 percent lower than a similar group of patients in a control group. (Care Level gets to split any savings greater than 5 percent.)

To learn more about the program:
- read this New York Times article

Related Article:
Families choose unlicensed home care. Report

BC of California fined $1M for cancellations

Thu, 22 Mar 2007 20:01:38 -0400

The California Department of Managed Health Care (DMHC) is bringing the hammer down on Blue Cross of California (BCC). The DMHC has fined BCC $1 million after finding that it systematically and illegally canceled policies held by chronically ill and pregnant policyholders. Under state law, California health plans may only cancel individual policies if a policyholder intentionally lied on an application to cover up a pre-existing medical condition. But BCC violated this standard regularly, using computer software and an entire dedicated department to identify and cancel the policies held by pregnant women and chronically ill patients regardless of whether they intentionally lied on their applications, the DMHC concluded.

WellPoint, which owns BCC, defended the cancellations, stating that the majority of the rescissions were "unquestionably proper." Some observers, meanwhile, are suggesting that BCC hasn't been punished enough--that the $1 million isn't a large enough fine to deter WellPoint from future violations, given its $56.95 billion in annual revenues. State regulators, for their part, continue to investigate other California health plans for similar alleged violations.

To learn more about the DMHC's conclusions:
- read this piece from the Los Angeles Times

Related Articles:
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Group offers disease mgmt outcomes guidelines

Wed, 06 Dec 2006 19:01:34 -0500

The Disease Management Association of America has issued guidelines for measuring outcomes in disease management programs, a move aimed at helping employers determine whether such programs actually reduce the cost of caring for chronic conditions. The guidelines offer several study design tips, including use of a "pre-post" design incorporating concurrent comparison or control groups, as well as using medical and pharmacy claims cost data to calculate the financial impact of DM programs. They recommend comparing the cost of caring for chronically ill patients with similar nonchronic populations as a method for examining cost trends. The DMAA guidelines also stress that both vendors and employers agree on a risk-adjustment method, to make sure that measures aren't unduly affected by the severity of the particular patients' conditions.

Get more background on the guidelines:
- check out the DMAA press release
- read this Business Insurance article
- review the DMAA's evaluation guidelines summary (.pdf)

Related Article:
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