While covering the uninsured has been a main focus of healthcare reform, millions more fall into the category of "underinsured': those with coverage, but not enough. The underinsured include the working poor whose employers don't provide full coverage, people who lose their jobs and their employer-subsidized insurance, and those who fail to understand the fine print in policy contracts and end up with less coverage than they expected.
Representatives from Miami-based Jackson Health System said its top 20 executives will volunteer to take a 4%-5% pay cut, drop their car and executive allowances, and consider giving up five days without pay. The move comes after county commissioners expressed dismay about the number of executives earning big salaries in Miami-Dade's public hospitals.
Senate Democrats are revisiting proposals to raise taxes on high-income people to help pay for an overhaul of the healthcare system. The main proposal getting renewed attention is one by President Barack Obama that would limit the federal tax deductions for higher-income families for mortgage interest and other widely claimed purposes.
Massachusetts' nearly three-year-old experiment in trying to insure almost everyone has been closely watched for evidence to inform the national healthcare debate. Now a study from the nonprofit Kaiser Family Foundation shows the effort has not provided much help to people whose employers offer coverage that is unaffordable or inadequate.
The Obama administration put drugmakers on notice that they will be forced to atone for improper marketing practices as prosecutors unveiled a record $2.3 billion settlement with Pfizer. Officials at the departments of Justice and Health and Human Services called the agreement a cautionary example of their strategy to team up with states to police errant healthcare businesses. The Pfizer unit Pharmacia & Upjohn pleaded guilty to a single felony charge that accused the company of marketing its anti-inflammatory drug Bextra for broader uses and higher dosages than those approved by the Food and Drug Administration.
Catholic Health Initiatives and Trinity Health will combine four Eastern Oregon-Western Idaho hospitals into a single local system. The agreement calls for transferring the three CHI facilities to Trinity Health, and creating a new regional healthcare system to be operated by Trinity Health, the two health systems said in a joint announcement Wednesday.
Three of the hospitals--Mercy Medical Center, in Nampa, ID; Holy Rosary Medical Center, in Ontario, OR; and St. Elizabeth Health Services, in Baker City, OR--are part of CHI, based in Denver. The fourth hospital is St. Alphonsus Regional Medical Center of Boise, a part of Novi, MI-based Trinity Health.
"Combining the strengths of our three hospitals with Saint Alphonsus appears to be the best strategy for the future of our healthcare ministry," says Kevin Lofton, president and CEO of CHI. "Beyond our common values and religious heritage, all four hospitals are dedicated to improving the health of the communities they serve."
"St. Alphonsus and Trinity Health have expressed a commitment to create a new regional health system which will sustain our ministries in Baker City, Ontario and Nampa over the long term, valuing our dedicated staff and recruiting much-needed providers to underserved communities," Lofton says.
Trinity Health President and CEO Joseph R. Swedish called the agreement "a historic day for the residents in Idaho and eastern Oregon who will soon benefit from an integrated regional health system."
Over the last several months, executives and board members at Mercy Medical Center, Holy Rosary Medical Center, St. Elizabeth's Health Services, and CHI have been exploring the benefits of aligning the three hospitals with another hospital or health system. If the facilities combine, all facilities will remain open and it is expected that most employees will continue in their positions. Following due diligence, the deal is expected to be finalized within the next several months.
CHI is the second-largest faith-based healthcare system in the nation, with 78 hospitals; 40 long-term care, assisted- and residential-living facilities, and two community health-services organizations operating in 20 states. Together, these facilities provided $536 million in charity care and community benefit in the 2008 fiscal year. CHI has more than 65,000 employees and annual operating revenues of $8.2 billion.
Trinity Health is the nation's fourth-largest Catholic healthcare system with 45 acute-care hospitals, 379 outpatient facilities, 29 long-term care facilities, and numerous home health offices and hospice programs based in seven states. Trinity employs 45,000 full-time staff and had $7 billion in annual operating revenue in 2008.
Hospitals, health plans, and physician practices could use stronger data that emphasizes quality metrics broken down by race, Hispanic ethnicity, "fine-grained" ethnicity, and language proficiency to help address existing disparities in healthcare—while at the same time monitoring improvements, according to findings by an Institute of Medicine (IOM) subcommittee.
Currently, efforts are under way to establish national standards for healthcare technology and performance measurements that reflect local data collection and reporting. However, it has been difficult to either combine or compare performance data stratified by race, ethnicity, or language need across payment and delivery systems, said the Subcommittee on Standardized Collection of Race/Ethnicity Data for Healthcare Quality Improvement in a new report.
In early 2009, IOM—at the request of the Agency for Healthcare Research and Quality—formed the subcommittee to examine approaches to standardization.
In its report, the subcommittee calls for the Department of Health and Human Services (HHS) to develop and make available nationally standardized lists for fined-grained or "granular" ethnicity, which is defined as locally relevant choices from a national standard list of approximately 540 ethnic categories. It also calls for making distinctions among spoken and written languages—providing a rating of spoken English language proficiency and determining one's preferred language for health related encounters.
In addition, HHS and the Office of the National Coordinator for Health Information Technology should consider adopting categories of race, Hispanic ethnicity, granular ethnicity, and language for inclusion in electronic health record standardizations, the subcommittee suggested.
Inclusion of standardized ethnicity and language data in electronic health record systems will make it possible to stratify quality performance metrics, combine data from various sources, and make comparisons across settings and payment mechanisms, the report said.
Similarly, states, accreditation agencies, standards setting bodies, professional organizations, and other federal agencies involved in the provision of healthcare services (for example, Department of Veterans Affairs and Department of Defense) could stimulate standardization by adopting the subcommittee's recommendations.
Also, HHS should issue guidance that recipients of HHS funding (e.g., Medicare, the Children's Health Insurance Program (CHIP), Medicaid, and community health centers) include data on race, Hispanic ethnicity, granular ethnicity, and language need in individual health records, the subcommittee said. This would permit data to be used to stratify quality performance metrics, plus encourage disparity reduction initiatives.
Pfizer Inc. and subsidiary Pharmacia & Upjohn Company Inc. will pay $2.3 billion—the largest healthcare fraud settlement in U.S. history—to resolve criminal and civil charges brought forward in several whistleblower law suits for illegally promoting the off-label use of its drugs, the Justice Department announced today.
In addition, Pharmacia & Upjohn Company will plead guilty to a felony charge for misbranding Bextra, an anti-inflammatory drug that Pfizer pulled from the market in 2005. Under the Food, Drug and Cosmetic Act, a company must specify the intended uses of a product in its application to FDA, and that drug may not be marketed for off-label uses. Prosecutors say Pfizer ignored the law and promoted Bextra for uses and dosages that the FDA specifically declined to approve due to safety concerns.
As a result, Pfizer will pay a criminal fine of $1.195 billion, the largest criminal fine ever imposed in the United States for any matter. Pharmacia & Upjohn will also forfeit $105 million, for a total criminal resolution of $1.3 billion.
In addition, Pfizer has agreed to pay $1 billion to resolve allegations under the civil False Claims Act that it illegally promoted four drugs – Bextra; Geodon, an anti-psychotic drug; Zyvox, an antibiotic; and Lyrica, an anti-epileptic drug—which reportedly prompted false claims to government healthcare programs for uses that were not medically accepted and, therefore, not covered.
The civil settlement also resolves claims that Pfizer paid kickbacks to healthcare providers to induce them to prescribe the drugs. The federal share of the civil settlement is $668.5 million and the state Medicaid share of the civil settlement is $331.4 million—the largest civil fraud settlement in U.S. history against a drug maker.
"Illegal conduct and fraud by pharmaceutical companies puts the public health at risk, corrupts medical decisions by healthcare providers, and costs the government billions of dollars," says Tony West, assistant attorney general for DOJ's Civil Division. "This civil settlement and plea agreement by Pfizer represent yet another example of what penalties will be faced when a pharmaceutical company puts profits ahead of patient welfare."
As part of the settlement, Pfizer will enter a corporate integrity agreement with the Office of Inspector General at HHS, with procedures in place to avoid or promptly detect future misconduct.
Pfizer General Counsel Amy W. Schulman says the settlements "bring final closure" for the drug maker. "We regret certain actions taken in the past, but are proud of the action we've taken to strengthen our internal controls and pioneer new procedures so that we not only comply with state and federal laws, but also meet the high standards that patients, physicians, and the public expect," Schulman says. "Corporate integrity is an absolute priority for Pfizer, and we will continue to take appropriate actions to further enhance our compliance practices and strengthen public trust in our company."
Mike Loucks, acting U.S. attorney for Massachusetts, says Pfizer had been skirting the law for a long time and that the massive fines fit the crimes. "At the very same time Pfizer was in our office negotiating and resolving the allegations of criminal conduct by its then newly acquired subsidiary, Warner-Lambert, Pfizer was itself in its other operations violating those very same laws," Loucks says. "Today's enormous fine demonstrates that such blatant and continued disregard of the law will not be tolerated."
Whistleblower lawsuits filed under the False Claims Act that are pending in Massachusetts, Pennsylvania, and Kentucky triggered this investigation. Six whistleblowers will receive payments totaling more than $102 million from the federal share of the civil recovery.
Marketers at Geisinger Health System wanted to create a memorable take-away to give to physician candidates, and they wanted something just a little more engaging than a coffee mug. So the Danville, PA, health system teamed with Wilmington, DE, agency Aloysius Butler & Clark to create a coffee table book filled with photography that highlights the organization's emphasis on first-class medicine and physician work/life balance.
"To recruit to rural northeastern Pennsylvania we wanted to emphasize our theme of clinical excellence and outstanding quality of life," says Cathy Connolley, associate vice president of marketing. "We have physicians or candidates that were in serious talks with and we wanted a higher-end piece to give them that was very compelling and left them with a feeling of excellence."
Marketers started giving the book to physician candidates who visited the organization last year. Connolley says it has a shelf life of about three years before they have to redesign it or create something new.
"We wanted to give them a takeaway that was a little more high-end than a coffee mug. We also wanted to get the point across about the marriage between the work/life balance," she says. "That you can come to this health system and practice the type of medicine that you would in New York City and also be able to enjoy the things that you love most."
Physician candidates that have received the book have been wowed by it, Connolley says. They appreciate that the book features some of Geisinger's top doctors.
"This area is so scenic and beautiful and we wanted to tie it back to our clinical excellence, so we featured some of our higher-end physicians, both sub-specialists and our primary care doctors, doing things in the outdoors to represent the fact that you can have that life/work balance here," she says.
Kaiser Permanente's latest "Thrive" campaign ads are just as visually stunning as the others in the series. One of the two new ads, released yesterday, focuses on technology and innovation in general, and electronic health records in particular.
The "Emerald City" spot, created by the Warren, MI-based Campbell-Ewald ad agency, depicts a fairy tale world that is part busy city and part quiet woodland forest. Old-growth trees are rooted in the middle of streets and between sky scrapers. All is calm and peaceful. Motorists, bicyclists, pedestrians, and deer (yes, deer) live together in harmony.
It's no secret that I'm a big fan of the Thrive campaign. I wrote about their "Kabuki" ad on the MarketShare blog a few months back, admitting that I couldn't stop watching it.
The Kabuki ad was about patient-centered care and a team approach to delivering healthcare. It's a concept that anybody could understand: Who doesn't want to be at the center of a team of caregivers who support and heal you?
EHRs a tough sell
I'm not sure, though, that the general public understands EHRs—much less makes healthcare decisions based on their availability. And I'm not sure that in this case, the message about their benefits to the patient is effective.
"By putting an end to paper medical records, we have ushered health into the digital age," the commercial's narrator says. "Saving lives, sometimes when seconds count. Managing chronic conditions. Making amazing new discoveries. And, oh yes, saving a lot of trees."
The ads reflect the Oakland, CA-based Kaiser's "commitment to the total health of its members and the communities it serves," according to a release. "As the nation seeks innovative solutions for reforming health care and reducing costs, Kaiser Permanente is leading the way in making technology a core tool for patients and providers with Kaiser Permanente HealthConnect®, the world's largest civilian electronic health record."
Put the patient at the center
The second new ad, "Connect," shows a man in front of a clear computer screen, interacting with his healthcare provider via e-mail, making an appointment online, checking test results, and monitoring his health through Kaiser's My Health Manager.
"We know technology can make you more connected," the narrator says. "But now it can make you more connected to your doctor though e-mail. Test results from home. Check records. Change appointments. Now doctors, nurses, techs, pharmacists are all digitally connected to each other, and ultimately connected to you. At Kaiser Permanente, we believe that if knowledge is power, shared knowledge is even more powerful."
It is much more effective in its messaging and eminently more relatable than the Emerald City ad (though just as cool to look at). Toward the end of the ad, the screen shows an interconnected web of healthcare professionals, with an avatar labeled "you" at the center. Like the Kabuki ad, it's all about the patient, something that the Emerald City ad doesn't quite get at.
Although healthcare organizations have created marketing around the latest clinical equipment (to varying degrees of success) marketing connectivity and electronic health records is fairly new. (Mayo Clinic is also doing some work in this area.)
To be effective I think that healthcare organizations are going to have to take a cue from the very benefit they're promoting—the fact that the patient is at the center of everything a healthcare organization does.
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