Archive for May, 2009

Fewer Hospitalizations Key to UnitedHealth Group’s $540 Billion Savings Plan

May 29th, 2009 by Melanie Matthews

Reduced hospitalizations would account for almost half of $540 billion in potential healthcare savings suggested by UnitedHealth Group, based on a review of its 15-step cost-saving proposal released this week. The self-described health and well-being company says preadmission programs at nursing homes and evidence-based care management programs can trim the number of unnecessary hospitalizations. The company has 13 other ideas for saving the federal government a total of $540 billion in healthcare costs over the next 10 years, including transitional case management, health coaching and the medical home model, according to a report from its new Center for Health Reform and Modernization.

The 15 cost-saving suggestions fall into four key areas:

A. Incentivizing Member / Beneficiary Use of High Quality Providers

  • Option 1: Member Incentives to Use Highest Quality Providers (Potential Savings ~$37 Billion)

    Assessment of quality and efficiency of providers using “episodes of care” analytics measured against evidence-based standards and efficiency benchmarks. Provides members with incentives to use highest quality physicians.

  • Option 2: Cancer Support Programs (Potential savings ~$5 billion)

    Voluntary guidance on cancer treatment best practices and patient options, including hospice care. Case management to prevent hospital readmissions between therapy sessions.

  • Option 3: Transplant Solutions Program (Potential savings ~$0.7 billion)

    Voluntary guidance for patients on selecting the best transplant centers in the nation for their condition.

B. Reducing Avoidable and Inappropriate Care

  • Option 4: Institutional Preadmission Program (Potential savings ~$166 billion)

    Provision of onsite nurse practitioners at skilled nursing facilities to manage illnesses and prevent avoidable hospitalizations.

  • Option 5: Transitional Case Management Program (Potential savings ~$55 billion)

    Follow-up with patients after leaving the hospital to reduce readmissions by checking on recovery progress and supporting adherence to discharge plans and recommended medical care.

  • Option 6: Advanced Illness Program (Potential savings ~$18 billion)

    Provides information and guidance to patients and their families about both their condition and the benefits of further treatment options including palliative care at the end of life.

  • Option 7: Disease Management for Congestive Heart Failure (Potential savings ~$25 billion)

    Voluntary coaching for members with higher-acuity chronic illness to ensure treatment compliance.

  • Option 8: Gaps In Care Program (Potential savings ~$1.4 billion)

    Voluntary intervention for members with chronic illness, but relatively good health to ensure ongoing treatment compliance.

  • Option 9: Integrated Medical Management (Potential savings ~$102 billion)

    Application of clinical evidence-based care management tools with targeted preventive care and patient education tools to reduce admission rates.

C. Incentivizing Physicians to Encourage High-Quality Care

  • Option 10: Patient-Centered Medical Home (Potential savings ~$20 billion)

    Establish a primary care physician as the central ongoing coordinator of patient care. Reduces inappropriate or duplicative treatments while ensuring needed ‘anticipatory’ care is provided.

  • Option 11: Physician Additional Compensation Program (Potential savings ~$24 billion)

    Rewarding physicians for providing comprehensive medical care and utilizing resources appropriately.

  • Option 12: Specialist Data Sharing (Potential savings ~$15 billion)

    Sharing comparative quality and effectiveness data with physicians to induce behavioral change towards evidence-based clinical practice.

D. Applying Evidence-Based Standards to Reimbursement Policies

  • Option 13: Radiology Benefit Management (Potential savings ~$13 billion)

    Application of clinical evidence to determine clinically appropriate diagnostic radiology studies.

  • Option 14: Radiology Therapy Management (Potential savings ~$5 billion)

    Application of clinical evidence to determine clinically appropriate usage of radiology therapies.

  • Option 15: Prospective Claims Review (Potential savings ~$57 billion)
    Analysis of claims before they are paid to detect upcoding, duplicate billing and billing for non-existent patients.

Wiring the Medical Home

May 28th, 2009 by Melanie Matthews

According to Dr. James Crawford, senior vice president for laboratory services and chair of the department of pathology and laboratory medicine at North Shore-Long Island Jewish Health System, an organization must prioritize IT implementation into its medical home, as too much at once can overwhelm the IT team. And in Medical Network One CEO Ewa Matuszewski's opinion, the patient-based registry is just the tool needed to take that first step in wiring your medical home.

In a HIN webinar entitled, "Wiring the Medical Home: Healthcare IT to Power a Patient-Centered Model," these panelists presented case studies on the use of health IT in the medical home and its impact on care access, quality and cost.

And you can listen to pre-conference comments from Matuszewski and Dr. Crawford here.

Cancer Therapies

May 21st, 2009 by Melanie Matthews

The CDC's National Center for Health Statistics ranks cancer as the second most common cause of death in the United States, with 559,312 deaths a year, or 22.8 percent of all deaths. This week's Disease Management Update looks at various cancer therapies as well as laws that some states are implementing to combat smoking-related cancers.

Innovative Health IT Work-Arounds

May 18th, 2009 by Melanie Matthews

Just 4 percent of physicians are using "extensive, fully functional EHRs," according to an HHS-Robert Wood Johnson study published in 2008 in the New England Journal of Medicine . Even so, many practices are implementing "makeshift or work-around HIT solutions to increase electronic access and give practitioners a better sense of what's happening with their patients," notes Dr. James Crawford of the North Shore-Long Island Jewish Health System. Dr. Crawford, who co-chairs the PCPCC's committee on health IT adoption, was surprised by the number of simple yet intelligent innovations submitted by respondents to the PCPCC's recent survey on health IT adoption by physicians. For example, an EHR-less practitioner in Camden, N.J., developed a patient registry for high utilizers of emergency services and then directed these patients to medical homes.

Our conversation with Dr. Crawford is this week's HealthSounds podcast. In other HIT news this week, New York offers $60 million
to install health IT in the medical home and the first of six Maryland hospitals wires its ICU for remote monitoring.

Benefit-Based Incentives That Tripled Participation in Workplace Wellness

May 18th, 2009 by Melanie Matthews

David Sensibaugh, director of Integrated Health at Eastman Chemical Company, recently described how HRA completion and wellness program participation tripled when a benefits-based incentive was introduced:

Before 2006, in any given year we had about 30 percent of our employees completing an HRA, and we needed to accelerate that dramatically to get up in the 75 percent-plus participation level. In 2006 we introduced an incentive for employees to complete a health risk assessment (HRA). If they did that, then their healthcare contributions for the next year would be $600 — or about $50 a month lower than that they would be otherwise. By introducing that incentive our participation jumped that first year from 30 percent to 94 percent. As we moved into 2007, we wanted to continue this journey and build on the momentum we had established. So in addition to completing the HRA, employees were encouraged to do something else, from an educational perspective, that would be aligned with one of four areas of focus, based on their HRA data: cardiovascular, obesity, stress and maintaining a healthy lifestyle.

With this incentive, 90 percent of our employees then met the condition during 2007 for the 2008 benefit year. The first year employees had to complete HRAs; 94 percent of our people did that. The second year, employees had to complete the HRA and do something else — participate in an Eastman Integrated Health-sponsored program. We were very pleased with those results. Not only did the HRA participation increase significantly — from 30 percent to 94 percent, which is about a 184 percent increase — but participation in other programs and activities increased significantly as well. Most notable of these is the increase in our healthy lifestyle coaching program called Healthy Steps, which went from about 350 participants to over 1800 participants. HealthFitness, our partner and outsource organization, managed all these things for us.

During 2007, in addition to completing the HRA, employees were encouraged to participate in an additional program. “Walk This Way” is one example of the many programs that would qualify as an Eastman Integrated Health-sponsored program. These programs help people meet that enrollment condition to obtain that $600 differential in their healthcare contribution. The participation in our walking program doubled between 2006 and 2007. In addition to participation, the results of the improvements and health risks are particularly noteworthy.

For HRAs during 2006 and 2007, well over 8,000 employees participated each year. The results indicate improvements in almost all risk factors; the body mass index (BMI) and the glucose, which is an indicator of diabetes, were the two that didn’t have an improvement. Across the board these comparisons between year one and year two are statistically significant, but the greater takeaway is that there remains a significant opportunity to improve these risk factors. We know that behavioral, lifestyle change coaching programs work. The challenge is to get people motivated to participate in these programs, so that they can achieve as well as sustain the needed behavioral change.

Healthcare Costs Declining for Some Conditions

May 14th, 2009 by Melanie Matthews

Healthcare costs are rising in the United States — surpassing $2 trillion in 2006, almost triple the $714 billion spent in 1990, and over eight times the $253 billion spent in 1980. With these figures in mind, it's refreshing to hear there are still some healthcare expenditures on the decline. Read on to find out which ones. Also in this issue of the DM Update, find out how high healthcare costs are preventing some patients from getting mental health treatments they need.

Mother’s Day Handwashing Part of Nursing Home Culture of Safety

May 11th, 2009 by Melanie Matthews

The bottle of hand sanitizer at the visitors' desk of my mother-in-law's nursing home was larger than usual on Mother's Day, to accommodate extra handwashing while the swine flu is still a threat. After swiping my visitor's badge, I saw that a state inspection report was one of several documents posted on a hallway bulletin board. It probably would have gone unnoticed had I not received LifeCare's tips to families searching for the right facilities for their older loved ones, issued for Nursing Homes Week May 10 - 16 and featured in this week's Healthcare Business Weekly Update. To uncover any potential deficiencies, LifeCare(R) recommends that families ask to see the most recent state-required survey or visit Medicare's NursingHomeCompare site. Also, visit each facility twice—once at an appointed time and once unannounced—and take your loved one along with you.

Also this week, learn how potentially harmful medication discrepancies are reduced by nearly a third when a computerized application to record and track patients' medications is used. We've heard this before: In Eight Steps to a Culture of Safety, Leanne Huminski, chief nursing officer of McLeod Regional Medical Center, shares the eight steps to creating a culture of safety that reduced adverse medical events at McLeod by 90 percent and greatly implified the medication reconciliation process.

EHRs Help Smokers Quit?

May 7th, 2009 by Melanie Matthews

While 70 percent of smokers say they would like to quit, only 7.9 percent are able to quit smoking without help. A story in this week's DM Update discusses the impact physicians can have on their patient's cessation efforts by simply asking them about their tobacco use and connecting them with cessation services. Read on for more about this and for some smoking cessation incentives from an industry leader.

Social Distancing, Not Social Networking, in Flu Season

May 4th, 2009 by Melanie Matthews

With seven confirmed cases of swine flu in New Jersey as of today — including one in our own county — it's hard not to feel a little anxious. Rather than overreact, common sense should prevail while we consider the nonpharmaceutical community mitigation measures recommended by the CDC for states with at least one confirmed case of swine flu. These measures include home isolation of cases, frequent handwashing, and certain "social distancing interventions" — such as the cancelling of large gatherings linked to settings or institutions with laboratory-confirmed cases. For a kid-friendly lesson on handwashing, families might want to visit NSF International's Scrub Club, a Web site that uses "Soaper Heros" like "Gel-Mo" to teach the benefits of clean hands.

For healthcare organizations, education of staff and patients may be the best medicine. A look back at the hospital reaction to the rising number of MRSA cases offers some lessons to consider during the current level 5 influenza pandemic alert. In a recent HIN e-survey, reported strategies included: “proper hand hygiene campaign among staff and physicians; reminders and education materials placed strategically throughout the medical center; and asking patients to ask their healthcare provider if he or she washed up before providing care.” Along with these basics, one hospital also implemented programs to educate patients, providers and staff members about MRSA; established protocols for the identification of patients at risk; and established protocols for the treatment of patients with MRSA.