Two months after seeking a nearly 10 percent increase in premium rates for a low-income health insurance product, Highmark Inc. is pulling back on that request. Instead, the Pittsburgh insurer will ask for a 4.9 percent increase to the monthly cost of Special Care, the lower-cost, lower-income "guaranteed issue" plan offered by each of the state's Blue Cross Blue Shield insurers. The plan, which costs about $162 a month in this region for an individual, became the best available option for many of the area's working poor when the state legislature and Gov. Tom Corbett declined to continue funding the state's popular adultBasic health insurance. The state's policy cost $36 a month for an individual, but was not available after February.
Federal health officials on Tuesday announced an ambitious plan to refocus health priorities in an effort to prevent one million heart attacks and strokes within five years. They plan to achieve the goal through partnership with organized medicine, health plans, pharmacists and a large drug store chain.
Called "Million Hearts," the effort seeks to create what Centers for Medicare & Medicaid Services administrator Donald Berwick, MD, called a new "alignment" between providers and others to get people to lose weight, stop smoking, control blood pressure, reduce cholesterol, and manage diabetes.
"There's hardly an American today who won't, without doubt, know somebody – a loved one, a friend, maybe even yourself – who will gain from this call to arms," Berwick said during a news briefing. "(This is) someone who will not have a heart attack or disabling stroke or another form of cardiovascular disability and therefore will live longer and a fuller and more joyous life" because of this campaign.
Added Health and Human Services Secretary Kathleen Sebelius: "With two million heart attacks and strokes a year, 800,000 deaths, just about all of us have been touched by someone with heart disease, heart attack, or stroke." But the cost of treatment is "a huge drain on our economy. Cardiovascular disease costs our country $444 billion every year in medical costs and lost productivity," or one of every six healthcare dollars.
"Yet we know that most heart attacks and strokes can be prevented with simple, low-cost care that's available today, but that sad truth is too any people who need that care don't get it."
Thomas Frieden, MD, director of the Centers for Disease Control and Prevention, also commented during the campaign rollout. "This will not cost a lot of new money but it will greatly increase our focus on getting value for our investments," he said. "We aim to reduce the number of people who need treatment and improve the quality of treatment for those who do."
The administration is focusing on what it calls the ABCs of heart disease and stroke:
• A – To make sure that everyone who is at high risk for cardiovascular disease takes an aspirin a day. At present, only 47% do, but the campaign's goal is to raise that to 65%.
• B – To make sure patients at high risk for high blood pressure maintain control. At present only 46% do. The goal is to raise that to 65%.
• C – To make sure people who need treatment for high cholesterol receive it. Currently, only 33% receive it but the Million Hearts drive seeks to raise that to 65%.
• S – Reduce smoking prevalence, currently at 19% of the population to 17%.
Additionally, the campaign seeks to reduce sodium intake by 20% from its current per person average of 3.5 grams per day, and cut by half the average American's consumption of calories from artificial trans fat.
HHS officials said they intend to "focus and align" measurement tools to simply reporting for healthcare providers on how well disease prevention benchmarks are being met. CMS plans to expand the role of the Physician Quality Reporting System (or PQRI), which provides bonus payments, and in the future payment reductions based on the reporting of quality information related to the ABCS. Currently no new reporting measures are planned but officials said that may change as the program gains momentum.
Additionally, they hope to use health information technology and electronic record systems to improve providers' tools to make sure patients receive appropriate care.
To learn new ways to prevent heart disease and stroke, the administration intends to focus on clinical innovations, perhaps through Medicare's 53 Quality Improvement Organizations or QIOs.
Other efforts tagged with the campaign include:
• The release by the CDC of $40 million total state health departments to find ways to improve cardiovascular health
• Efforts by the U.S. Food and Drug Administration and the Food Safety and Inspection Service to find ways to reduce sodium in processed and restaurant foods "to put more control into consumers' hands."
• A $2 million pharmacy outreach project from the CDC to help pharmacists provide additional advice to patients with high blood pressure.
• CMS is releasing $85 million for Medicaid Incentives for Prevention of Chronic Diseases, a project set forth by the Patient Protection and Affordable Care Act, for 10 states.
• $4.2 million from the CDC to seven national community-based organization networks.
The administration touted "alignment and support" from the following organizations and companies:
• Walgreens is offering free blood pressure testing and consultations with a company pharmacist or nurse practitioner.
• The American Heart Association will monitor progress of the initiative's goals and help patients access heart disease management tools online.
• The YMCA or The Y plans to expand diabetes prevention program and other efforts to address population risks for diabetes and cardiovascular disease.
• The American Pharmacists' Association and its foundation "will encourage its more than 62,000 members to engage in the Million Hearts Campaign by raising awareness with their patients and their communities." The National Alliance of State Pharmacy Associations and the Alliance for Patient Medication Safety will encourage state pharmacy association to plan supportive activities, according to an HHS news release.
Karen Ignagni, president of America's Health insurance Plans, said her group strongly supports the Million Hearts initiative and is "eager to collaborate with other stakeholders."
A former hospital executive was convicted on Monday of conspiracy and fraud for creating fake consulting contracts to funnel money to New York state legislators in exchange for influence in Albany. David Rosen, who was chairman of MediSys Health Network, a not-for-profit hospital and healthcare group, had been indicted in April along with former state assemblyman William Boyland,Jr., state senator Carl Kruger and others. But Rosen's case was severed from the other defendants. "This is a sad, even tragic case," U.S. District Judge Jed Rakoff said in an opinion finding Rosen guilty after a month-long bench trial in Manhattan federal court."It reveals how a widely-admired hospital administrator who diligently sought to better the health care of impoverished communities nonetheless chose to entangle himself in the bribing of state legislators."
Hospital employees spend 10 percent more on healthcare, consume more medical services, and are generally sicker than the rest of the U.S. workforce, according to a study released on Monday. The cost difference was even greater when dependents were taken into account, with healthcare costs 13 percent higher, including medical care and prescription drugs. The study, conducted by Thomson Reuters Healthcare, analyzed the health risk and utilization of 1.1 million hospital workers and compared them with 17.8 million health plan members across all industries around the country. Researchers did not look at the causes for the disparity.Healthcare workers and their dependents were more likely to be diagnosed and hospitalized to treat asthma, diabetes, congestive heart failure, HIV, hypertension and mental illness. It found that the average cost of healthcare for hospital employees and their dependents was $4,662 per year - $538 higher than that of the general population.
Ohio Valley Medical Center, East Ohio Regional Hospital and the parent corporation of both will pay $3.8 million to settle allegations of health care fraud, U.S. Attorney William Ihlenfeld said Monday. The deal ends an investigation into allegations that the hospitals submitted false claims to Medicaid and Medicare from January 2005 to August 2010. Both hospitals are owned by Ohio Valley Health Education & Services Corporation. OVMC is in Wheeling, and East Ohio is in Martins Ferry, Ohio. Ihlenfeld said the penalty is severe because the compensation agreements the hospitals had with local physicians were improper under federal law and involved significant amounts of money. "Illegal agreements like these drive up the cost of health care, and in the end, we all pay for it in the form of higher taxes," he said.
The National Institutes of Health is funding a five-year study that aims to establish the first set of standard procedures to diagnose and treat sepsis in the emergency room. Lead researcher Derek Angus, chair of the department of critical care at the University of Pittsburgh Medical Center, says the key to the project is determining whether there are "golden hours" during which specific procedures can halt the progress to severe sepsis. In June, the Centers for Disease Control and Prevention reported that hospitalizations for sepsis more than doubled between 2000 and 2008 to over one million. Treatment costs increased an average of 12% annually to $14.6 billion. The CDC cites an aging population with more chronic illnesses, greater use of drugs that suppress the immune system and invasive procedures that can carry microbes into the body, and bugs that are increasingly resistant to antibiotics. Some of the rise may be due to increased recognition of the disease.