Fact File

Cancer patients may have a different point of view on oncology drug decisions than nonpatients, according to a survey conducted by Truven Health Analytics. Healthcare consumers were asked whether they agreed or disagreed with a recent decision by a large cancer center to not offer a new medication that has similar ben­efits and side effects as an existing drug but is more costly. The fact that those who have had the most experience with cancer were the most likely to agree with the can­cer center's decision suggests that those who have experienced both the benefits and side effects of cancer drugs, and possibly out-of-pocket costs for these medications, may have more realistic attitudes toward cancer treatments.

The inappropriate use of emergency department services is growing, resulting in care that is more costly and lacks continuity. The ability to measure the inappropriate use of these services is key to addressing this issue, but there has been little agreement on how to identify and categorize inappropriate ED visits. When the issue has been studied, the focus has been primarily on the Medicare, Medicaid, and uninsured populations. But people covered by private insurance are just as likely to overuse the ED.

The U.S. healthcare system is replete with waste. The key to avoiding waste in this area is meticulous attention to payment integrity issues. That is, making sure that the correct payment is made for the correct member for the correct service to the correct provider. For this study, Truven Health Analytics identified six payment integrity algorithms with the highest potential for savings. In addition to identifying potential waste, some of these algorithms have a clinical integrity dimension. Care that is wasteful or potentially fraudulent is also often of poor quality.