chronic diseases

Study: More than half of insureds on chronic-care meds

Wed, 14 May 2008 06:59:54 -0400

A new study suggests that for the first time, more than half of insured Americans are regularly taking prescriptions for chronic health problems. The most popular drugs include those used to lower blood pressure and cholesterol, according to Medco Health Solutions, which manages prescription benefits for about one in five Americans.

According to Medco data, 51 percent of American children and adults were taking one or more prescription drugs for a chronic condition, marginally up from 50 percent the previous four years and 47 percent in 2001. Use of medication for chronic conditions was spread across age groups. However, the biggest jump in the use of such medications was in the 20- to 44-year-old age group, due largely to more use of drugs for depression, diabetes, asthma, attention-deficit disorder and seizures.

To learn more about the study:
- read this Associated Press article

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PA health plans pay PCPs to track care

Tue, 13 May 2008 06:59:54 -0400

A group of Pennsylvania health plans have come together to create a program paying family doctors and other caregivers to manage patient care more closely. Among other things, the program will make providers more accessible to patients through phone calls and email, as well as educating patients in better self-care. Plans involved, which include Independence Blue Cross, Aetna and four other insurers, are looking to spend $13 million over three years to finance the first phase of the initiative. All told, more than 150 primary care doctors are participating within 32 primary care practices, and about 220,000 patients in southeastern Pennsylvania will participate, which makes this one of the largest efforts of its kind in the U.S. The program is part of Gov. Ed Rendell's chronic-care model for the state, which should rollout statewide by year-end.

To learn more about the program:
- read this Philadelphia Inquirer article

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Medicare disease management pilot ending this year

Thu, 24 Apr 2008 06:59:56 -0400

Three years ago, CMS hired eight private disease management firms to set up chronic care improvement programs for beneficiaries. The programs, which reached as many as 150,000 seniors enrolled in Medicare, use trained nurses or health coaches to reach out to patients and make sure they were taking the right self-care steps. The idea was that by doing so, patients would have fewer hospitalizations and less trips to the emergency department, saving Medicare some money. During the run of the project, three of the eight firms actually dropped out, citing cost overruns--which is bad enough--but the worst was yet to come.

CMS now is closing the project down, having concluded that it hasn't lowered claims. The agency will end the pilot in at the end of the year unless the remaining five companies can cut Medicare claims by $600 to $800 per patient per month from now through December. Since that's unlikely, it seems the pilot is doomed, despite the fact that some physicians (and members of Congress) are lobbying to keep it alive for other reasons.

To learn more about the pilot's results:
- read this AMNews piece

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Medicare commission recommends primary care increase

Thu, 10 Apr 2008 06:59:58 -0400

Hoping to "reward a career in primary care" and decrease shortages, the Medicare Payment Advisory Commission has recommended that Congress create a budget-neutral adjustment that will boost payments to doctors providing primary-care services. The adjustment would be payable for both office and home visits, plus visits to patients in nonacute facilities.

Under MedPAC's recommendations, HHS would set criteria that would determine which doctors would be eligible for the extra payment. Along the way, it appears that specialty physicians could lose financially under this proposal, so they're asking MedPAC to consider another approach.

To learn more about the recommendations:
- read this Modern Healthcare article (reg. req.)

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NQF develops coordination of care measures

Wed, 02 Apr 2008 07:59:54 -0400

The National Quality Forum plans to begin developing quality measures related to coordination of care over the next 15 months, a move that could help to boost the emerging trend toward giving patients medical homes. NQF already measures some aspects of care coordination, but the new standard will expand its focus. Now, it's beginning research on relationships among doctors of various specialties, provider roles and family understanding of treatment plans. It will use this data to develop standards for medication management, transitions and handoffs. Execs there hope the standards will help medical teams work together more effectively.

To learn more about the standards:
- read this Modern Healthcare piece (reg. req.)

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Senators ask CMS to keep disease-mgmt program

Tue, 18 Mar 2008 07:59:56 -0400

Last month, CMS decided to discontinue its planned three-year Medicare Health Support program--aimed at managing chronic diseases more effectively--arguing that initial results hadn't met quality, cost and beneficiary-satisfaction goals. But four U.S. Senators involved in health policy, including Sens. Lamar Alexander (R-TN), Bob Corker (R-TN), Edward Kennedy (D-MA) and John Kerry (D-MA) are calling on CMS to change its mind, arguing that CMS hasn't gathered enough data yet to make sure a decision. Right now, Aetna Health Management, Green Ribbon Health, Health Dialog Services Corp., Healthways and XLHealth provide advice, education, med management and personal services for 150,000 Medicare patients with heart disease or diabetes. Healthways, for its part, is contending that the program would meet or even exceed the program's goals despite some initial problems with patient selection.

To learn more about the debate over this program:
- read this Modern Healthcare piece

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Humana debuts national complex care mgmt program

Thu, 06 Mar 2008 06:59:55 -0500

Humana is launching a care management program for chronically ill Medicare members in several states. The program, which provides care through both telephone and field-based social workers, nurses, health coaches and Humana managers, is designed to cut down on unnecessary trips to the hospital. Humana workers will be tasked with making sure that seniors have the right medications, transport to medical appointments and home-safety measures such as ramps and grab bars. The program is being overseen by Tampa, FL-based Green Ribbon Health, one of five Medicare Health Support pilot programs. Green Ribbon operates in Florida, North Carolina, South Carolina and Georgia, and plans to start in Kentucky later this month. It will expand to another nine states by the end of September, the health plan said.

To learn more about the program:
- read this article from The (Louisville, Ky.) Courier-Journal

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MN officials focus on chronic disease care

Wed, 20 Feb 2008 06:59:56 -0500

Increasingly, states are beginning to focus on management of chronic diseases as a means for getting massive healthcare costs under control. This week, Minnesota is joining the pack. Legislators currently are developing a proposal designed to improve the management of care for people with heart disease, diabetes and other costly chronic illnesses. In the future, legislators expect to file bills shifting healthcare spending from specialty care to primary care.

These ideas have popular support. Just this week, a group of former legislators, a retired football star and representatives from business, labor and medical interests gathered together to hold a press conference and urge politicians to keep their focus on chronic disease.

To learn more about Minnesota's plans:
- read this Minneapolis Star-Tribune article

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MD groups struggle with Medicare incentive goals

Tue, 19 Feb 2008 06:59:58 -0500

It looks like the initial stages of a new CMS demonstration project have turned out to be something of a disappointment. In April 2005, CMS began offering annual bonuses to 10 physician groups if they met cost savings and quality targets. While all 10 implemented care-coordination programs during the first performance year, only two of the groups met CMS bonus criteria, according to a new report from the Government Accountability Office. However, that's not solely the groups' fault. The GAO report said that part of the reason physician groups had trouble meeting the goals was the design of the demonstration project, including the fact that CMS gave no feedback to the groups until after the third year had begun. Along the way, the GAO report suggested that it might be difficult to broaden enrollment in the demonstration project--even without design challenges--given that all of this round's participants were larger than the average medical group size for the United States.

To learn more about the demonstration project:
- read this Modern Healthcare piece (reg. req.)

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Report:Number of U.S. primary care MDs falls

Wed, 13 Feb 2008 06:59:54 -0500

A new study underscores the point that the number of U.S. doctors specializing in primary care is falling, though stats suggest that the gap is being covered by doctors who move here from other countries. According to a new report from the General Accountability Office, there were 22,146 American doctors in residency programs for primary care practice, down from 23,801 in 1995. Meanwhile, the number of international medical graduates training in primary care climbed from 13,025 in 1995 to 15,565 in 2006, the GAO report concluded.

The presence of foreign-born physicians goes well beyond primary care. At this point, in fact, one in four new physicians is an international medical graduate, according to Sen. Bernie Sanders (I-VT), who spoke at a Senate Health, Education, Labor and Pensions Committee meeting where the report was presented.

To learn more about the report:
- read this Associated Press article

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