iLoveBenefits: Industry News Blog

“Back – Boost” – anticipating future strains

I wonder how many other diseases might share this linkage to pre-emptive ‘immunology engineering’?

Technique might strengthen protection provided by flu vaccine Researchers found that an influenza infection triggers the immune system to protect not only against the circulating flu strain it is designed to fight, but also other strains that have infected an individual in the past, according to a study published in Science. This “back-boost,” as researchers called it, may allow the creation of flu vaccines that anticipate future strains, preemptively heading off an outbreak. Reuters (11/20)

Changing the paradigm and reach of the traditional office practice

Nurse-led protocol tied to better chronic disease managementAn analysis found nurse-led outpatient disease management protocols were associated with significant improvements in HbA1C, systolic blood pressure and lipid levels in patients with diabetes, hypertension and hyperlipidemia. The nurses followed a protocol for medication titration, according to the study reported in the Annals of Internal Medicine. Renal and Urology News (7/18)

Doctors agree that PAs, NPs improve care, productivityA Jackson Healthcare survey revealed about 75% of doctors who employed advance-practice professionals such as physician assistants and nurse practitioners said doing so helped improve patient care and practice efficiency, while two-thirds reported that PAs and NPs are handling tasks that formerly were handled by doctors. Sixty percent of respondents perceived the increasing role of PAs and NPs positively, researchers said. Nurse.com (7/17)

The Cost of Drugs is a HUGE Issue

This piece from Karen Ignagni

“A blank check in the name of innovation won’t work anymore”

Posted on July 7, 2014 by AHIP

AHIP CEO Op-Ed Drives Home Challenge of Specialty Drug Prices

What if the solution to a public health crisis was, at the same time, the biggest obstacle to success? That’s the dynamic facing the country as we try to eradicate Hepatitis C, a chronic liver disease afflicting more than three million Americans. A new treatment, Sovaldi, holds the potential to nearly wipe out this terrible disease, but at $1,000-per-pill, it’s so costly that its price threatens access for those who need it so desperately.

Taking to CNN with an op-ed this morning, Karen Ignagni, CEO of America’s Health Insurance Plans, lays out in real terms the challenge that drugmakers are presenting when they price their treatments at such astronomical levels. As Ignagni notes, Sovaldi “holds remarkable promise. But the manufacturer of this drug, Gilead Sciences, has created an enormous obstacle that is straining our health care system: its eye-popping price… If every person with hepatitis C were treated with Sovaldi alone at this price, the cost would be more than $268 billion.

For some perspective, consider that in 2012, the United States spent $263 billion for all prescription drugs.”The price of the drug “will have a tsunami effect across our entire health care system,” she writes. “Because the cost of health insurance is fundamentally a reflection of the price of health care services, the excessive price of Sovaldi unavoidably puts upward pressure on premiums for everyone with private coverage. It will also strain state Medicaid and Department of Veterans Affairs programs.

A recent analysis found that senior citizens on Medicare Part D could see premiums as much as 8% higher next year because of the price of this one drug. And it’s been projected that California’s Medicaid spending on Sovaldi and the accompanying drugs could potentially outpace what the state spends in a year on K-12 and secondary education combined.”

It would be one thing if Sovaldi were the only drug being priced at these once-unthinkable levels. But alas, “Startling as the price of Sovaldi is, it’s just the canary in the coal mine,” Ignagni continues. “More and more specialty drugs are coming on the market, with tremendous promise to save and improve lives but also with exorbitant price tags. Although these specialty drugs only account for 1% of the prescription drugs in this country, they already represent 25% of the total cost, on the way to 50%.”It’s a trend that simply cannot continue if we hope to have sustainable medical innovation.

“Asking for a blank check in the name of innovation won’t work anymore. Not when it stands in the way of solving a public health crisis. Not when it threatens state Medicaid budgets and the success of Medicare Part D, and not when the pricing threatens the very innovation that is giving so many hope,” she writes.

Read the entire piece on CNN.com here. – See more at: http://www.ahipcoverage.com/2014/07/07/ignagni-a-blank-check-in-the-name-of-innovation-wont-work-anymore/#sthash.YVOLgQdM.dpuf

How can disruptive innovation improve spine care?

The following article excerts are provided by permission of the author, John Ventura.

“It goes without saying that the field of spine care is replete with variation, waste and misuse. Direct costs for spine care have risen almost exponentially over the past three decades, while indirect costs (those typically associated with lost productivity) have followed suit. (3) In spite of these exorbitant expenditures on spine care, our outcomes as measured by disability are worsening. Many investigators have identified spine-related disorders as one of the costliest health conditions society faces. The need for change is obvious, but what change and how do we get there?”

To read more and understand the author’s proposal on how to bring Christensen’s concept of disruptive innovation to spine care go to: http://www.beckersspine.com/spine/item/21390-constructive-disruptive-innovation-first-touch-and-spine-care

 

HMO Redux ? Have we learned our lessons?

“As the role of primary care expands in the evolving healthcare landscape, there has been increasing discussion about expanding the team, and re-tasking members of those teams to allow everyone to “practice up to their licence.” This is a major part of the patient-centered medical home, and integral to making any such transformation successful.”

Then there is this…

“The patient needs to call and reach my office. A telephone encounter is created in the EHR. Now I have to stop what I’m doing, and “create” a referral to the dermatologist, as if this was some sort of magical, healing, useful thing. More often than not we need to select some benign (or made up) diagnosis (“dermatitis” or “nevus, non-neoplastic”) that will allow the patient to be seen, since we most likely do not know why they are there, and allow the dermatologist to be reimbursed by the insurance company.

It’s not just that I don’t want to do this work, it’s not just that it’s tedious work, but it’s work that no one should have to do. A ridiculous administrative burden has been created that prevents every one of us, no matter the level of our licensure, from being able to do the jobs in healthcare that we are desperately trying to do, and that we desperately want to do.”

http://www.medpagetoday.com/PatientCenteredMedicalHome/PatientCenteredMedicalHome/45788?isalert=1&uun=g436319d1316R5533480u&utm_source=breaking-news&utm_medium=email&utm_campaign=breaking-news&xid=NL_breakingnews_2014-05-15

So are ACO and patient-centered care just recreating the very reasons that HMOs failed? Of course there are all of the improvements and tools that are now being applied, that didn’t exist in the 1990’s HMO era. But from a public relations perspective, have we learned the lessons of the past on the parts of the physician, the physician’s office and the patient?

Study Examines Effectiveness of Automated Approaches for Receiving Patient Feedback

A new study supported by the Agency for Healthcare Research and Quality (AHRQ) suggests that many patients who do not improve as expected after a medical appointment don’t take further action to address unresolved problems. The study found that systematic follow-up, including a live follow-up call and those made by an interactive voice response system, can potentially identify and connect patients to needed care. “Exploration of an automated approach for receiving patient feedback after outpatient acute care visits” appeared online March 8 in the Journal of General Internal Medicine.

 

Researchers evaluated patients seen in outpatient settings for evaluation and treatment of a new health problem. The patients received a live follow-up call one week after their visit and via an interactive voice response system (IVRS) three weeks after their visit to determine their satisfaction with the diagnosis and treatment(s) provided. The study showed that automated telephone feedback systems can feasibly be used to follow-up on patient outcomes in outpatient settings. Further research on the effectiveness of this technology is needed to determine the role of automated telephone feedback systems in ambulatory care settings.

 

Select to access the abstract: http://www.ncbi.nlm.nih.gov/pubmed/24610308.

Data, Information, knowledge, technology tools — equals better care

Electronic tool cuts medication errors by 58% in studyAn electronic system that records and reviews each child’s medication history helped Boston Children’s Hospital cut medication errors by 58%, according to data presented at the Pediatric Academic Societies annual meeting. During the study period, researchers also found the medication history documentation grew from 89% to 93%. There were no errors during the study resulting in permanent harm, intensive care unit admission or patient resuscitation. BeckersHospitalReview.com (5/6)

Providing a written plan. . . of care

Most cancer patients enter survivorship with little direction from oncologists or primary care providers, according to a national survey.

Two-thirds of 1,130 oncologists said they always or almost always discuss survivorship with patients, but only a third told patients where to seek cancer-related or other care. Fewer than 5% of oncology respondents provided patients with a written plan for survivorship care.

Read more here: Of 1,020 primary care providers surveyed, 12% reported regular discussions about recommendations for survivorship care or provider responsibility, as reported online in the Journal of Clinical Oncology.

Most who follow me know that I have a vision for how health care will evolve. The next two big things that need to occur are transparency of pricing – what patients are expected to pay for the services they receive – estimates if not actual prices based on the insurance they have and the current terms of that insurance. And not necessarily in this order a plan of care.

Let me explain what is meant by a plan of care. It goes well beyond the story in the Journal of Clincal Oncology. That is just one example.

It is a plan that every person should have. It is the equivalent of a financial plan. It is something that the patient has the key to access, a portal and a document through which to view and understand their medical condition and the actions that they or their caregivers need to take to optimize the outcomes that patient is seeking. It is something that the patient enables others including their providers and caregives to view and to add to with their special knowledge and information. It spans every episode of care. Whether that is a prevention episode, a wellness episode, an acute episode, a chronic episode, even a secondary prevention episode.

It enables hospital discharge instructions to be cleanly handed off to family caregivers, rehabilitation caregivers, other physcians or nurses caring for the patient. It enables the primary care physician to view what all other parts of the health system are contributing to the health of the patient. It provides a means of communicating with the patient while in the office and to be sure that the instructions are clear when they leave the office. It helps turn the office visit into a counselling session rather than simply a visit and script.

It links physician to nurse, pharmacy to physician, hospital to rehab or nursing facility. It helps turn siloed health care services into a system of organized and informed health processes focused on the patient.

Health care technology and consumers meet

On April 10, PricewaterhouseCoopers’ Health Research Institute released a new report that suggests the health sector’s “center of gravity is shifting toward consumers and new tech-savvy players are moving fast to capitalize on the change.  These new entrants are poised to shake up the industry, drawing billions of dollars in revenue from traditional healthcare organizations while building lucrative new markets in the burgeoning New Health Economy.”

Does this improve outcomes or provide incremental revenue?

Is point-of-care ultrasound the new stethoscope?
A new paper espouses the benefits of hand-held ultrasound devices over the iconic stethoscope, arguing the convenience and power of ultrasound will improve diagnosis. Writing in the journal Global Heart, Drs. Jagat Narula and Bret Nelson of the Mount Sinai School of Medicine question why sonography isn’t used more widely. However, Dr. Reid Blackwelder, president of the American Academy of Family Physicians, says the stethoscope remains valuable and warns wider use of sonography could bring additional costs — both for equipment and the tests that might follow the initial assessment. CBS News (1/24), LiveScience.com (1/23), USA Today (1/24)

So, I am not against advances, but is there evidence that the outcomes are better than with a stethoscope? I know it will be more expensive. The article talks about it leading to more tests, too.

On the other hand, how about personal medicine and getting these devices as apps with sophisticated computer software that links to a ‘benchmark’ database to inform patients of potential next steps? Does that lower the number of office visits and procedures vs. putting the technology only in the hands of the clinician?

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