Archive for April, 2006

Organ Donation: A Different Sort of Relief Effort

April 25th, 2006 by Melanie Matthews

A reminder in a financial newsletter prompted a discussion in my home last night. April is “Donate Life Month,” which celebrates those who have donated organs and encourages more people to consider organ donation. Many Americans already support this effort: in 2005, more than 28,000 organ transplants were completed in the United States, more than any other period in history.

But more donors are needed. According to The Organ Procurement and Transplantation Network , as of 9:11 a.m. this morning, 92,024 people were on waiting lists for organ transplants. (Some candidates have multiple registrations if he or she is waiting at more than one center, or is waiting for multiple organs.) This wait takes a physical and emotional toll on these patients and their families, as well as a financial toll on the healthcare organizations supporting them.

To understand this human bottleneck, it’s worth a look at how this country recruits potential donors. The United States has an opt-in approach for organ donations, where potential donors consent to the process by indicating on their drivers’ licenses, completing and carrying a donor card or notifying their families of their wishes. Despite the millions spent on educating Americans about these enrollment processes, only 30 percent of Americans are registered organ donors today.

This prompted my family to review our driver’s licenses. Nowhere on my own New Jersey driver’s license—renewed in February 2005—does it state that I am an organ donor or provide a place for me to indicate this. I know my previous license (an older format) had a place for me to check this option, and a look at my nephew’s older license confirmed this. According to the New Jersey Department of Motor Vehicles, a driver must ask for the organ donor registration form . Once the driver completes the form, their driver’s license would identify them as an organ donor. If I rely on this option, I won’t have another chance to register as a donor until I renew my license in August 2008.

At present, there is no national organ donor registry, although more than 20 states have created their own donor registries.

In contrast, more than 21 European and Asian countries have switched to an “opt-out” or presumed consent system, which assumes that citizens will donate their organs unless they (or in some countries their next of kin) say they will not. Many of these governments have set up a “refusal list,” where citizens not wishing to donate organs may register. This is an ethically and politically charged issue, but the bottom line is that presumed consent is one way to address the shortage of organs in the United States and save lives.

This country may be years away from an opt-out system, but there are other steps we can take to boost awareness and donor registration in this country. Creating additional opportunities to register—ones with easy public access and the means to validate donor data—is one suggestion. Home and health insurance renewals, healthcare organization open enrollment, annual medical check-ups, school registrations, school board and government elections, municipal tax payments and local library visits are logical times to offer donor sign-ups.

We Americans are a generous bunch, accustomed to donating blood and responding quickly to relief efforts at home and abroad. According to a 2001 report sponsored by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Special Programs, Division of Transplantation, a low rate of family consent to donation is one of the major barriers to organ donation. One donor can provide organs, bone and tissue for 80 or more people in need. Why not make an unselfish gesture today and relieve family from making a difficult decision at an emotional time by signing up to be an organ donor?

P.S. By 12:31 p.m. today, there were 92,023 people on the waiting list for organ donations—one less than when I started this entry. You can make a difference.

Mandating Health Insurance Coverage

April 18th, 2006 by Melanie Matthews

A few weeks back I blogged on how several states are now requiring employer-sponsored health plans to offer coverage to “children” into their twenties, in most cases even if they are no longer full-time students in an attempt to address the high uninsured rate among young adults.

Massachusetts is the latest state to take a stab at its uninsured population.

Massachusetts Gov. Mitt Romney, a Republican, signed a sweeping healthcare reform bill intended to cover 90 percent to 95 percent of the uninsured in Massachusetts over the next three years. It requires everyone in the state to buy health insurance by July 1, 2007.

Starting July 1, 2008, individuals without health insurance will lose the portion of their state tax refund equal to 50 percent of an affordable health insurance premium, and monthly penalties will be assessed.

Robert Blendon, professor of health policy and political analysis for the Harvard School of Public Health, said there was no official determination, when the legislation was passed, on what is and is not “affordable” health insurance. A committee is supposed to come up with so-called “objective standards,” he said.

Under the law, a new entity called the Commonwealth Care Health Insurance Connector will be created to allow individuals to buy “affordable” health plans on a pretax basis, according to Romney’s office.

This mechanism is unique because it will contract with private health insurers to provide individuals insurance at a pretax, group rate, said Blendon.

This bellweather state will be closely watched to see what impact this reform bill has. How will consumers respond to the mandate? What impact will the “affordable” health plan have on healthcare costs? Will insurers be willing to write these plans?

If successful in Massachusetts, this could become a national model for addressing the problem of the uninsured.

And maybe it’s not such a bad model. In all other aspects of healthcare, consumers are being given more responsibility – from deciding what providers to use to determining what treatments to seek and how to spend money in the HSA.

All states require that consumers purchase insurance for their cars; maybe it’s not such a bad idea to require insurance for ourselves!

E-Health Best Practice: Providing Medical Decision Support and an Incentive When Employees Need It Most

April 6th, 2006 by Melanie Matthews

Imagine that you or a family member is diagnosed with a critical illness. Then, imagine having an hour on the phone with practicing physicians and research staff from the country’s top medical schools—say, Harvard Medical School or Duke University—to ask questions about your condition and find out about best practices and latest treatments. Only for those who can afford concierge medicine, you say? Think again.

A HIN staff member brought to our attention the efforts of Honeywell, a Morristown, N.J.-based maker of aerospace products, in this area. We’re intrigued by their program as well as the unique incentive attached to it. Along with some other Fortune 500 companies, Honeywell has taken its corporate healthcare information portal HealthResource one step further to offer its 70,000+ employees access to a medical decision support (MDS®TM) services from Massachusetts-based Consumers Medical Resources.

Available at no cost to workers and their families with critical illnesses, MDS pairs the patient and their family with physicians and researchers at five of the country’s top medical schools. After an hour-long in-depth conference call, the medical team prepares a packet of reliable, personalized research about the patient’s condition as well as strategies and questions to prepare them for their next consultation.

Buoyed by the success of its efforts, Honeywell is currently offering $500 in a tax-free health reimbursement account to employees and their families who consult MDS for any of eight procedures historically found to have more than one treatment option yet patients are presented with only one treatment choice. Procedures eligible for the incentive include carotid artery surgery, coronary artery bypass graft, hip replacement, hysterectomy, knee replacement, lumpectomy/mastectomy, prostatectomy and several lower back surgeries.

More than 1,500 Honeywell employees and their families have tapped the service since its launch in 2004. Honeywell pays CMR $1.35 per employee per month for the service, and we can’t argue with the outcomes and ROI presented in recent press coverage and Honeywell’s own employee literature:

Based on the information they learned from MDS:

ï‚· Seventy percent of utilizing employees and family report an improvement in their quality of life or comfort;

ï‚· Seventeen percent of participants changed doctors; and

ï‚· Thirty-one percent switched to a treatment considered the best practice.

In its first year of offering the service, Honeywell witnessed a $2.80 return for each dollar it spent on the service. In one case alone, an employee avoided back surgery after consulting with MDS doctors and turned to a combination of physical therapy and yoga instead, saving Honeywell $36,000 in direct medical costs alone. Last May this employee hiked to the bottom of the Grand Canyon and back.

We’d like to hear from other companies employing this combination of consumer empowerment and education to raise the quality of healthcare while harnessing healthcare costs. Please post a comment to this blog entry to describe your efforts.