Great Article on Medical Advances

The March issue of HealthLeaders has an great cover story on the various medical breakthroughs that will change the business and delivery of health care. One I found of particular interest:

One wireless device in the pipeline could improve medication compliance. It fits onto a prescription bottle and alerts patients when it's time to take their pills—and reminds them if they forget. In trials now at the Center for Connected Health, the device senses when a patient unscrews the cap on the prescription bottle and sends the information through a secure network to an online site. "I'm using it myself and I find it very helpful," says Joseph C. Kvedar, MD, director of the center, a division of Partners HealthCare in Boston.

"Adherence to medication alone can lower costs," Kvedar says. "It's a powerful tool, and just about every person should have some kind of medication device when we get them to the point where they're affordable and reliable."

As accountable care, bundled payments, and pay-for-performance become more common, improving health outcomes with wireless technology and other tools and devices makes business sense, Kvedar says. Partners is also using such cutting-edge technology to differentiate itself in the marketplace, he adds.

As I have mentioned in previous posts, managing the health care costs of their members will be critical for any managed care organization. Increasing medication compliance through this type of technology is something that should be explored and perhaps offered to members.

Employees Still Not Stepping Up

The latest survey on employee participation in employer health promotion programs is not very encouraging:

Employers are frustrated that too many of their workers are failing to change their unhealthy habits and take advantage of health and wellness programs that include financial incentives, according to a survey by Towers Watson and the National Business Group on Health.

As a result, some employers are "accelerating" efforts to find ways to further motivate employees and also tighten their requirements for participation in certain healthcare plans, says Ted Nussbaum, senior consultant for Towers Watson, a global professional services company, and co-author of the survey. The National Business Group on Health is a nonprofit association of large employers.

'As employers continue to be more health-focused, they are beginning to target and reward those workers who demonstrate a real commitment to making positive lifestyle changes,' Nussbaum says.

The survey, Raising the Bar on Health Care – Moving Beyond Incremental Change, states that the effort to change employee behaviors related to health has been a 'major obstacle for many companies.' Still, most companies have no plans to abandon their health promotion programs and will continue their existing strategies, according to Nussbaum. More than 500 employers participated in the survey—the 15th annual NBGH/Towers Watson Employee Survey on Purchasing Value in Health Care—conducted between November 2009 and January 2010.

I wonder how many of these same companies communicate to their employers what their poor health habits costs them in lower raises and bonuses and "skinnier" benefits. It is amazing but many employees do not understand this connection.

ACOs Show Promise

A critical component of controlling health care costs is moving away from the present fee for service payment structure which promotes unnecessary care in many cases. One proposed solution to FFS payments are Accountable Care Organizations which will provide care for a "pre-paid" fee and also will be rewarded with additional payments if certain quality measures are met. What is the latest with ACOs? According to Mark McClellan, former, CMS head, they show promise:

For the past four years, he said ACO programs have shown improvements in quality and many lead to lower costs. While there are some technical issues that must be addressed, he said, "It seems like a promising foundation for future work," McClellan said.

"One of my first experiences at CMS, I started hearing about integrated provider groups and independent practioners trying to do things to improve quality—like having nurse practioners in disease management, and pharmacists [following up] on medication adherence. They showed me the numbers and these things were actually working. Unfortunately they were getting killed on Medicare reimbursement fees." At that point, CMS embarked on ACO pilot programs, he said.

How well insurers partner with ACOs will be critical for the industry's success in the coming years.

PSA Testing a Waste of Time

There is an amazing op-ed piece in the NY times regarding PSA testing by the man who invented it, Richard Ablin.

In an editorial in today's NYTimes, Richard Ablin, who discovered PSA (the enzyme that is the target of the test), publicly disavowed the test, calling it a "hugely expensive public health disaster". He went on to detail the statistics: "American men have a 16 percent lifetime chance of receiving a diagnosis of prostate cancer, but only a 3 percent chance of dying from it. That's because the majority of prostate cancers grow slowly. In other words, men lucky enough to reach old age are much more likely to die with prostate cancer than to die of it." [emphasis added]

The cost of prostate hysteria comes to about $3 billion a year for the tests, plus the pain and discomfort and sexual dysfunction - and cost - of men treated unnecessarily.

One study found "1410 men would need to be screened and 48 additional cases of prostate cancer would need to be treated to prevent one death from prostate cancer."

Another study found "94% of the cancers detected with the routine PSA blood test would not cause death before the age of 85."

PSA testing is the perfect example of unnecessary care in this country.

One Week Later: Reflections on the HC Summit

There obviously has been a great deal written about the 7.5 hr. HC summit held last Thursday. Obama to no one's surprise displayed an incredible knowledge of the issues. But I was surprised by a few things. First, many Republicans repeatedly mentioned how poll after poll showed people were against HC reform. While this is true, why didn't the President or other Dems mention that a Kaiser poll showed that HC reform rose in popularity when people were informed about its specific provisions (e.g., out-lawing pre-existing conditions exclusions)?

And while all agreed that the cost of care needed to be controlled and that 30% of prescribed care in this country was unnecessary, no one talked specifically about what needed to be done. As I have mentioned in previous posts, moving away from a fee-for-service reimbursement system would be the Number 1 way to reduce costs. The Dems legislation calls for funding of pilot accountable care organizations under Medicare or ACOs. ACOs would likely be a consortium of providers who agree to care for a minimum of 5,000 patients for a pre-determined fee. Many details need to be worked out but I think ACOs are likely our best chance for cost of care control. More to come about them in future posts.

PWC Report on What Employers Want from Health Insurers

Price Waterhouse Coopers released a survey last week of what large and small group insurers want from health insurers which is available on their website. In short employers value technology and wellness but want better ways to engage employees and manage costs. Satisfaction from large employers dropped 5% from 2008 while satisfaction from small employers (surprisingly) held steady. Key recommendations include:

• Look beyond the provider discount strategy.
• Assist in the coordination of care.
• Educate the employer and employee about their health coverage.

In short, employers are looking for health insurers to take a much more active role in controlling costs. One way to show this would be to actively approach providers regarding episode based payment pilots. Episode based payments raise an incredible amount of issues but just sitting on the sidelines I don't think is an option. Health plans who have strong relationships with the provider community have an edge on this development because it will take an incredible amount of trust to successfully implement.

What Do Health Insurers Do Now?

No matter what happens in the next few weeks to health care reform, health insurers will still need to focus on controlling costs and engaging members. The increasing cost for health insurance will continue to squeeze employers so those health insurers who show they can manage care not just cost will be successful.