Study: Better blood pressure control with doctor-pharmacist team

Researchers found that doctors are better able to control patients’ high blood pressure when they work closely with pharmacists because medications are intensified and used more effectively. The doctor-pharmacist team approach already is being used in several areas and may also help control other chronic diseases such as diabetes, high cholesterol and asthma. HealthDay News

Health Care: GE Gets Radical

It’s offering only high-deductible, consumer-directed plans. That will save millions but may damage morale

By Jena McGregor

It’s been a hard year to work at General Electric (GE). Salary freezes have hit its famously performance-driven employees, with some managers taking pay cuts. The price of GE stock, which once made millionaires out of even hourly workers, has gone nowhere as the rest of the market has risen. A 68% dividend cut—the first in 71 years—has stung execs who rely on a heavy dose of restricted shares.

And now GE is making changes that could deal another blow to morale. The company is forcing its 75,000 salaried U.S. employees and 8,000 retirees under the age of 65 to choose what’s known as a consumer-directed health plan, which includes deductibles that run as high as $4,000 a year. Traditional plans, where employees pay higher premiums in exchange for predictable co-pays up front, are no longer available for salaried workers. One employee says his colleagues “are looking at this as a cut in pay.”

GE says the plan is being rolled out to make employees better health-care consumers and to coincide with its new “Healthymagination” strategy, a companywide initiative for health-care innovation. While GE says its future cost savings are unclear, people with knowledge of the situation estimate it could save $1 billion over the next decade or so. With three tiers of premiums and deductibles, GE spokesperson Sue Bishop notes, employees still have options. “It’s not that different from their car insurance,” she says. “You get to choose the amount of your premium, and that determines the amount of your deductible.”

VARIABLE COSTS

The total cost of care will depend, of course, on the individual. Consumer-driven plans can save money for healthy workers who rarely visit a doctor or shop around. Typically, employees have lower premiums and save pretax dollars in health-savings accounts to pay much higher deductibles, with companies providing contributions to offset expenses. (GE will fund up to $1,000 for two of the three tiers.) While GE’s plans offer free preventive care, for the first time, it’s making smokers pay an extra $625 a year.

Workplace experts say that while many companies are adopting consumer-directed plans—about half now offer one, according to consultancy Watson Wyatt Worldwide (WW)—most offer them as part of a broader menu. Wharton School professor Peter Cappelli argues that this isn’t the year to be piling big changes on an already battered employee base. “There’s the death-by-a-thousand-cuts issue,” he says. Veteran recruiter Peter Crist adds that the health-care change could add to the grousing he hears from GE executives. “At the high end, it’s not just the money,” says Crist. “It’s the aggravation.”

Indeed, there are indications that many are anxious about their new benefits, even if they can take comfort in knowing GE’s salary freeze will lift in 2010. Some are overwhelmed by the complexity of the new plans. GE is offering Web tools, town halls, and coaches to help. But James N. Cawse, a former staff scientist at GE Global Research, says: “I’m a statistical analysis guy and I finally had to draw up a spreadsheet to make any sense of it.”

Medical ‘Pay for Performance’ Programs Help Improve Care — But not Always, Study Finds

PhysOrg.com
University of California – Los Angeles
November 24, 2009

Recent studies by The UCLA School of Public Health have found that California’s pay for performance program that was implemented in 2004, has greatly improved the overall experience of patient care.

However, the amount of improvement often depends on the incentive focus area. Too much focus on physician production may not lead to better health care while incentives used to focus on clinical quality and patient-clinician interaction seem to provide the best results.

For complete story, click here.

State of Abortion in the United States

Abortion Financing: Private Insurance

According to data presented in the Kaiser Family Foundation’s Women’s Health Policy Fact Sheet, published in June 2008:

• Five states (ID, KY, MO, ND, OK) restrict insurance coverage of abortion services in private plans: OK limits coverage to life endangerment, rape or incest circumstances; and the other four states limit coverage to cases of life endangerment.
• Twelve states (CO, IL, KY, MA, MS, NE, ND, OH, PA, RI, SC, VA) restrict abortion coverage in insurance plans for public employees, with CO and KY restricting insurance coverage of abortion under any circumstances.
• U.S. laws also ban federal funding of abortions for Federal employees and their dependents, Native Americans covered by the Indian Health Service, military personnel and their dependents, and women with disabilities covered by Medicare.

Source: Kaiser Family Foundation. Women’s Health Policy Facts, June 2008. http://www.kff.org/womenshealth/upload/3269-02.pdf

Health Care a Budget Buster

This from David Broder of the the Washington Post:

The day after the Congressional Budget Office (CBO) gave its qualified blessing to the version of health reform produced by Senate Majority Leader Harry Reid, a Quinnipiac University poll of a national cross section of voters reported its latest results.

This poll may not be as famous as some others, but I know the care and professionalism of the people who run it, and one question was particularly interesting to me.

It read: “President Obama has pledged that health insurance reform will not add to our federal budget deficit over the next decade. Do you think that President Obama will be able to keep his promise or do you think that any health care plan that Congress passes and President Obama signs will add to the federal budget deficit?”

The answer: Less than one-fifth of the voters — 19 percent of the sample — think he will keep his word. Nine of 10 Republicans and eight of 10 independents said that whatever passes will add to the torrent of red ink. By a margin of four to three, even Democrats agreed this is likely.

That fear contributed directly to the fact that, by a 16-point margin, the majority in this poll said they oppose the legislation moving through Congress.

Republican budget experts such as former CBO director Douglas Holtz-Eakin amplify the point with specific examples and biting language. Holtz-Eakin cites a long list of Democratic-sponsored “budget gimmicks” that made it possible for the CBO to estimate that Reid’s bill would reduce federal deficits by $130 billion by 2019.

Perhaps the biggest of those maneuvers was Reid’s decision to postpone the start of subsidies to help the uninsured buy policies from mid-2013 to January 2014 — long after taxes and fees levied by the bill would have begun.

Even so, this depends on two big gambles. Will future Congresses actually impose the assumed $420 billion in cuts to Medicare, Medicaid and other federal health programs? They never have.

And will this Congress enact the excise tax on high-premium insurance policies (the so-called Cadillac plans) in Reid’s bill? Obama has never endorsed them, and House Democrats — reacting to union pressure — turned them down in favor of a surtax on millionaires’ income.

http://www.jewishworldreview.com/david/broder112309.php3

Can Medical Homes Thrive Outside a Medical Neighborhood

 

The Commonwealth Fund recently launched a five-year national initiative to help primary care safety-net clinics become high-performing patient-centered medical homes. The Safety Net Medical Home Initiative, which is cofunded by eight local foundations and led by Qualis Health and the MacColl Institute for Healthcare Innovation, aims to develop a replicable and sustainable implementation model for medical home transformation. A new newsletter, The Medical Home Digest, reports on the activities of this five-state, 68-clinic demonstration project. The inaugural issue features reports from the field, including an essay on engaged leadership by Ed Wagner, M.D., M.P.H., director of the MacColl Institute, and an interview with Alicia Eng, practice team manager for the Factoria Clinic, the site of Group Health Cooperative’s first medical home demonstration.

 

 

Hospital Readmission Rates

Editor’s note: It would be interesting to understand what the Lean Six Sigma ‘Entitlement’ rate is for 30-day all cause hospital readmisstion rates are for Medicare patients. In otherwords, what is the best that another comparable hospital has attained on this measure.

The unadjusted 30-day all-cause hospital readmission rates for Medicare patients discharged after heart failure were: 23.0% in 2004, 23.3% in 2005, and 22.9% in 2006.

Source: “Recent National Trends in Readmission Rates after Heart Failure Hospitalization”, Circulation: Heart Failure, abstract only, November 10, 2009,http://circheartfailure.ahajournals.org/cgi/content/abstract/CIRCHEARTFAILURE.109.885210v1

Health Care Innovation

Policymakers should consider the impact of reform proposals on innovation.  For example, proposals that increase spending on diagnostics and therapeutics could encourage such innovation.  Expanding price controls, government health care programs, and health insurance regulation, on the other hand, could hinder America’s ability to innovate, say Whitman and Raad.

Source: Glen Whitman and Raymond Raad, “Bending the Productivity Curve: Why America Leads the World in Medical Innovation,” Cato Institute, November 18, 2009.

For text:

http://www.cato.org/pubs/pas/pa654.pdf

When Medicaid Will Pay for Long-Term Care

• By Bob Carlson
• Published November 20th, 2009

Many people still expect that government programs, such as Medicare and Medicaid, will pay for their long-term care needs. Unfortunately, these programs provide limited assistance for long-term care needs.

 

Medicare, the program for those 65 and older, has restricted coverage for stays at long-term care facilities. The coverage generally is only for brief periods of rehabilitation after surgery or injuries. Medicare pays only about 15% of national nursing home expenses. It does not pay much of the cost for those in assisted living facilities or receiving home health care.

 

Medicaid offers extended long-term care coverage and pays about 45% of total nursing home expenses. But to receive the coverage you must meet the Medicaid asset limits. This generally means you must be impoverished by Medicaid standards. There are strategies people use to qualify for Medicaid, but they became less practical after changes in the law about 10 years ago and even less practical after a 2005 law. Now, it is difficult to qualify for Medicaid without impoverishing yourself long before any coverage is needed.

 

Medicaid is a joint federal-state program. There are umbrella federal rules, but the states are allowed to add to them by making eligibility more restrictive. You have to know not only the federal rules but any modifications your state makes. This post reviews the federal rules and some state variations.

http://www.kciinvesting.com/articles/10149/1/When-Medicaid-Will-Pay-for-Long-Term-Care/Page1.html

Update on Health Care Legislation 11/23/09

This from the National Business Group on Health:

November 23, 2009

Though Senate Democrats came together over the weekend long enough to vote 60-39 to begin debate on health care legislation over the weekend, moderates and left-of center Democrats quickly went their separate ways over the government insurance option (aka the public plan option).

Lingering disagreements among Democrats over this issue, cost-cutting, new taxes, and the socially divisive issues of abortion and illegal immigration do not point to swift passage of a bill anytime soon.  Unexpected controversies could emerge such as one floated by the gun lobby that suggests that the legislation could make it harder for people to get gun licenses if doctors share patient data with the government and that wellness incentives may require gun owners to pay more for health insurance.  We do not expect the President to sign legislation until early next year, possibly in February.

Four key Senators in the middle, Blanche Lincoln (D-AK), Mary Landrieu (D-LA), Ben Nelson (D-NE) and Joe Lieberman (I-CT) reiterated that they would not vote for the bill as it currently stands unless it changed significantly.  Apparently without the 60 votes to overcome a potential filibuster, Majority Leader Harry Reid (D-NV) has reportedly begun talking again with the two Republican Senators from Maine, Olympia Snowe and Susan Collins, trying to strike a deal for their votes.

As Senators attempt to insert sweeteners for their constituents in the bill and the media focuses on high-profile controversies, one little-noticed deal apparently reached late Friday between Senator Max Baucus (D-MT) and Senator Ron Wyden (D-OR) spells major adverse implications for employer plans.

The agreement would allow low-income employees (with incomes at or below 400% of poverty, or about $88,000 for a family of 4 in 2009) whose share of premiums are close to what the bill considers unaffordable (between 8 and 9.8% of their incomes) to use their employer health subsidies to buy health insurance exchange coverage.  Such a move, if expanded to include more employees and ultimately all of them as Senator Wyden hopes, would unravel employer risk pools and raise employer plan costs.

This change and other ideas that raise costs for employer plans do not belong in the bill.