Given that the average adult over age 55 juggles six to eight medications daily, the ability to consolidate pill-popping is no minor matter. "I'm more likely to be able to sustain a medication regimen if I only have to take it three or four times a day," said Michael Wolf, an associate professor of medicine at Northwestern University who studies drug safety. "Seven or eight times a day is complicated to fit into your daily schedule." His sister, who has lupus, sometimes takes up to 16 different drugs, he noted. "Why can't we standardize prescriptions?" Why indeed? The idea has been kicked around for years. Nearly three years ago, the Institute of Medicine proposed that pharmaceutical manufacturers adopt a universal dosing schedule that would make it possible for people to take medications at just four times of day: morning, noon, evening and bedtime. Virtually all drugs could be formulated to fit into this framework, Dr. Wolf said: "It's ridiculously simple, an incredibly basic idea."
Major employers across the country, eager to curb fast-rising healthcare costs, are opening their own state-of-the-art health centers where doctors and nurses provide medical care to workers often just steps from their desks. The cost-cutting strategy has been embraced by dozens of companies—typically large employers that are self-insured and pay their own medical claims, including Walt Disney Co., Qualcomm Inc. and American Express Co. Many of the health centers are full-service medical offices equipped with exam rooms, X-ray machines and pharmacies. Some provide on-site appointments with dentists, dermatologists, psychiatrists and other specialists who treat life-threatening illnesses. Executives say providing in-house medical care keeps workers healthy and productive. But the clinics also help the bottom line by reducing absenteeism and slashing employers' medical bills for outside doctors and emergency rooms.
The number of companies with 20,000 or more employees that provided fitness centers, subsidies or discounts grew by 11% from a year earlier, according to a 2010 national survey by Mercer, a benefits consulting firm. Another survey, by the Society for Human Resource Management, shows that the proportion of companies offering gym benefits has held steady since 2007. During the same period, many employers were paring retirement and other financial benefits because of the recession. The reason, according to many studies, is that wellness benefits provided in the workplace yield more productive employees who require less healthcare. That translates into savings on health insurance for companies and workers. A 2010 Harvard Business Review article found that wellness programs, of which fitness is a component, can return as much as six times their cost to the companies that sponsor them. Another 2010 review by a separate team of Harvard researchers, published in the journal Health Affairs, concluded that "medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent."
Banner Health is among more than three dozen hospital systems nationwide with "eICUs," which provide remote care for the most critically ill patients. Banner's system, which began about five years ago, includes a command center at Banner Desert Medical Center in Mesa that links doctors and nurses to 15 hospitals and about 450 beds in Arizona, Colorado and Nebraska. Starting this year, doctors in Tel Aviv and Southern California also joined the system that remotely transmits critical patient information such as heart and breathing rates. The information allows the remote critical-care doctors to guide and work with doctors and nurses who actually provide the hands-on treatment. The system, which Banner calls iCare, is available to every patient in intensive care, but patients are offered a chance to opt out when they are admitted. By now, Banner doctors and nurses have become accustomed to working with virtual counterparts; Banner started iCare in early 2006. Medical specialists have said in the past, though, that while they welcome the help and ability for remote doctors to quickly detect problems, they worry about turning patients over to doctors they don't know.
One of the linchpins of the federal health care law passed last year is a requirement that each state establish an insurance exchange ? a marketplace where individuals and small businesses can compare and buy private insurance plans. The federal government will provide states with startup money to establish exchanges, which must be open for business by 2014. If a state declines to start one, the federal government can step in and do it. With a January 2013 deadline to have an exchange plan ready, lawmakers in Missouri —particularly conservatives who have been outspoken in opposing the healthcare law—face a difficult proposition: set up the healthcare plan many of them oppose or do nothing and invite even more federal intervention.
Encouraged by the healthcare overhaul, medical providers are slowly moving toward accountable care organizations, where health care providers are working to better coordinate the treatment of elderly patients insured by Medicare. Some of the ideas include more electronic record keeping and specialized case managers to keep closer tabs on patients. The hope is that medical care will improve and costs will be reduced. Medicare would share the savings with providers. The program is voluntary so all patients will continue to get the same benefits under traditional fee-for-service Medicare. Similar programs are popping up elsewhere in the private insurance market, including in the Chicago area, as health plans look for new ways to save money. But Medicare is moving aggressively under the Affordable Care Act to move away from the existing fee-for-service program, which pays doctors and hospitals no matter how care turns out.