Today, the Utah health system is one of a handful in the nation with a data system that can track cost and quality for every one of its 26,000 patients. That data is shared with doctors and nurses for further input about ways to streamline cost and improve care. In the first year, the system shaved nearly $2.5 million from a $1 billion budget, and officials say they're in a better position to negotiate with insurers because they know precisely how much it costs to perform a particular procedure.
Analyzing big data can predict patients' future risk of metabolic syndrome and allow individuals and clinicians to work together on preventative steps that save lives and money. While organizations have used a lot of big data projects to discern trends, a study conducted by Aetna and GNS Healthcare analyzed data from almost 37,000 members of an Aetna employer customer who opted in for screening of metabolic syndrome -- which can lead to chronic heart disease, stroke, and diabetes. GNS analyzed information such as medical claims records, demographics, pharmacy claims, lab tests, and biometric screening results from a two-year period.
Massachusetts General Hospital will take the unusual step of questioning all patients about their use of alcohol and illegal drugs beginning this fall, whether they are checking in for knee surgery or visiting the emergency department with the flu. How often have you had six or more drinks on one occasion, caregivers will ask, or used an illegal drug in the past year? If the battery of four questions reveals a possible addiction, doctors can summon a special team to conduct a "bedside intervention" and, if needed, arrange treatment. The mandatory screening program is part of a broad plan to improve addiction treatment at the Boston teaching hospital and its community health centers and is an example of an expanding national and statewide effort to reach substance abusers earlier and in mainstream medical settings.
If you offer it, will they come? Insurers and some U.S. senators have proposed offering cheaper, skimpier ?copper? plans on the health insurance marketplaces to encourage uninsured stragglers to buy. But consumer advocates and some policy experts say that focusing on reducing costs on the front end exposes consumers to unacceptably high out-of-pocket costs if they get sick. The trade-off, they say, may not be worth it. Coverage on the health insurance marketplaces now is divided into five types of plans that require different levels of cost-sharing by consumers. All the plans cover 10 so-called essential health benefits, including hospitalization, drugs and doctor visits. Preventive care is covered without any cost-sharing.
Last week, I attended the American Society of Health Economists' biennial conference in Los Angeles, where this year's theme emphasized the translation of economics to policy. Thus, it wasn't surprising that the conference organizers chose to discuss payment reform in a plenary session. Unbeknownst to most consumers, both the government and private-sector insurers have been making significant changes to how they reimburse hospitals and physicians for the services they provide to patients. Are economists being too hard on healthcare providers? Certainly not. Economists can offer strategies to control costs, while maintaining or improving the quality of care. Doing so can make healthcare and insurance affordable to more Americans.
Doctors should stop performing routine pelvic exams, a key component of regular physicals for women, an influential medical group said Monday. There is no evidence that such pelvic exams are useful and plenty to suggest that the procedure provokes fear, anxiety and pain in many women, the American College of Physicians said in a new practice guideline for doctors. The college's guideline was published in the Annals of Internal Medicine and was accompanied by an article reviewing the scientific evidence. The recommendation applies only to routine checkups for healthy women, not to women who visit the doctor's office with medical complaints or who are pregnant.