Healthcare Business Week in Review: Healthcare Reform, Medication Adherence, Readmission Rates

Friday, October 18th, 2013
This post was written by Cheryl Miller

Women are in charge when it comes to choosing their family’s healthcare coverage needs.

That’s the bottom line from a new survey from Cigna, which says that, regardless of where they live or who their insurer is, women are the CFOs and CMOs of their households.

Among their top concerns about healthcare coverage, in light of new reforms, are whether they can afford insurance, and care for their elderly parents. The extensive survey covers everything from how many women understand reform (1 in 10) to what steps they’re taking to manage costs (94 percent are using lower cost prescriptions).

A lack of family and social support is one of the seven chief barriers to medication adherence, says Thom Stambaugh, chief pharmacy officer and vice president of clinical programs and specialty pharmacy at CIGNA® Pharmacy Management. If a patient has no friends or family to discuss their health and required medications with, they are more likely to skip them, which is why it’s important to understand which barrier applies to a particular individual when trying to resolve medication compliance issues, and then find a solution around it.

Breast cancer screening, cervical cancer screening, and weight assessment and nutrition counseling for children were among the areas Kaiser Permanente received top marks in, according to the NCQA’s Quality Compass® data, which ranked the company number one in 13 out of 43 effectiveness of care measures. Out of nearly 500 commercial health plans in the nation, no other health plan received more than five No.1 rankings, according to Kaiser officials.

Regions of the United States where doctors and hospitals are consolidated into large networks are more likely to have accountable care organizations (ACOs), according to a new RAND Corporation study.

Other factors associated with the formation of ACOs include a greater occurrence of payment risk sharing at hospitals, larger integrated hospital systems and primary care physicians practicing in large groups.

A region’s average household income, per capita Medicare spending, enrollment in Medicare Advantage Plans and physician density were not associated with formation of accountable care organizations.

Same-hospital readmission rates are an unreliable predictor for all-hospital readmissions rates, but that rate is what CMS penalizes hospitals for, according to research from the University of Michigan (U-M) Health System, presented at the 2013 Clinical Congress of the American College of Surgeons.

By tracking readmission rates solely within their own facility, instead of looking at rates at other hospitals, officials aren’t getting enough information to effectively target areas for quality improvement, researchers say.

And lastly, sophisticated analytics behind today’s health risk assessments or health risk appraisals (HRAs) provide employers, payors and providers an aggregate view of population health and the raw material for the development of prevention and lifestyle change programs. Tell us how your organization uses HRAs to improve population health in our online survey by October 15, 2013 and get a FREE executive summary of the compiled results.

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