Customers of UnitedHealth Group, who use certain asthma drugs and antidepressants, will soon get a price break. The health insurance giant will soon offer $20 discounts off monthly copays for members who refill certain prescriptions within about 30 days after the last prescription runs out—essentially rewarding patients for adhering to treatment plans.
Geneticists at the University of Miami Miller School of Medicine say a $20 million philanthropic gift will bring them a step closer to cracking the genetic code of autism and other complex disorders. The money will be used for technological upgrades that will allow scientists to analyze the DNA of thousands of people with autism and their families.
Democrats and Republicans actually agree on a bundle of proposals that could make medical insurance better for millions of Americans. The consensus proposals include such popular ideas as barring insurance companies from denying coverage to people with preexisting injuries and illnesses, cutting insurance coverage off when a policyholder gets sick, and imposing a lifetime cap on benefits. Lawmakers from both parties are increasingly eyeing the areas of agreement as a possible fallback if the president's more ambitious approach collapses.
The H1N1 virus was four times more likely to send African Americans and Hispanics to the hospital than whites, according to a study that offers one of the first looks at how the virus has affected different racial groups. The report echoes some unpublished information from Boston that found three out of four Bostonians hospitalized from the H1N1 flu were black or Hispanic. The cause for the difference more likely because blacks and Hispanics suffer disproportionately from asthma, diabetes, and other health problems that make people more vulnerable to the flu.
Two senior House Democrats said an agreement struck with centrist Blue Dog Democrats in late July on a public health insurance option might be altered before a healthcare bill reaches the House floor. Under the Blue Dog deal, which was included in legislation that passed the House Energy and Commerce Committee, the HHS secretary would negotiate payment rates to doctors and hospitals under the new public plan. But that provision drew sharp criticism from more liberal House Democrats, who want those payment rates to be pegged to the Medicare program. They argue that negotiated rates would give insurance companies undue influence, and wouldn't lower costs enough.
One of the unusual things about the swine flu is that it often strikes young, healthy people, while skipping over the elderly. The most recent evidence comes from the Chicago Department of Public Health, which reports that kids between 5 and 14 were 14 times more likely than the those over 60 to come down with the H1N1 flu.
The United States Conference of Catholic Bishops has been lobbying for three decades for the federal government to provide universal health insurance, especially for the poor. Now, as President Obama tries to rally Roman Catholics and other religious voters around his proposals to do just that, a growing number of bishops are speaking out against it.
Health insurance company employees are speaking out about the characterization that their companies are the "villains" in healthcare reform. Employees said they are being criticized as part of a campaign to create a new government insurance plan that would compete with private insurers. Some workers said that unlike other contributors to the country's healthcare problems, such as the doctors who overprescribe, the hospitals that fail to control infection, and the consumers who do not take care of themselves, insurance companies are faceless, impersonal, and distant.
The Joint Commission's latest Sentinel Event Alert, which was released this morning, urges healthcare leaders to become more involved in the prevention of medical errors at their facilities, as well as to take more responsibility when errors do occur.
The alert, titled "Leadership committed to safety," reflects many of the changes made to the leadership chapter in The Joint Commission's 2009 Comprehensive Accreditation Manual for Hospitals, which contains the standards hospitals need to comply with to attain accreditation by The Joint Commission.
The alert asks leaders to recognize that if there is a failure in the organization, no matter the result, they are ultimately responsible, and acknowledging that will go a long way toward fixing those errors. Additionally, the alert reminds leaders that building a culture of safety is part of preventing medical errors. Doing so is something that can only truly happen when leaders buy in to the idea and show that they are not just talking about a culture of safety, but that it is something they live every day. By taking safety into consideration with each decision made about their facilities, leaders can lay the groundwork for making their organizations highly reliable.
"Healthcare leaders are directly responsible for establishing a culture of safety," says Mark R. Chassin, M.D., M.P.P., M.P.H., president of The Joint Commission. "This Alert provides leaders with concrete strategies for demonstrating a commitment to safety and to improving patient outcomes."
The alert lists 14 specific recommendations to leaders. One of these is creating a transparent environment that encourages reporting of near miss events and allows staff members to talk freely about the facility's trouble spots without being penalized.
Similar to this, the alert recommends leaders support staff members who are involved in a medical error by recognizing that errors are most often the result of system failures, rather than assigning blame to one or two people involved. Additionally, allowing involved staff members to participate in the route cause analysis and investigation will help prevent future errors.
However, the alert also recommends that leaders recognize the need to create a functioning disciplinary policy for those staff members who exhibit specific, defined behaviors.
In the midst of the healthcare reform debate, one topic seems to be missing: Addressing the problem of patients who fail to take their medications as prescribed by their physicians.
According to a study I reported on earlier this month from the non-profit New England Healthcare Institute (NEHI), this problem may be more widespread than expected. More than a third to a half of all patients in the U.S. are not taking their medications. The subsequent cost to the American healthcare system: approximately $290 billion annually in avoidable medical spending.
"In this era where we're looking both at improving patient outcomes and in reducing overall healthcare spending, improving adherence is really a significant link to [addressing] health reform," said Valerie Fleishman, NEHI's executive director.
Many barriers, NEHI noted, exist blocking better medication adherence—cost, side effects, challenges of managing multiple prescriptions, patients' understanding of their disease, forgetfulness, cultural and belief systems, imperfect drug regimens, patients' ability to navigate the health care system, cognitive impairments, or a reduced sense of urgency because of a lack of symptoms.
In many instances, adherence rates were found by NEHI to be lower among patients with chronic conditions than among those with acute conditions. Also, studies have shown that the length of time a patient continues to take a prescribed drug could be correlated with a drop in adherence shortly after a drug is prescribed.
For instance, among a large group of patients with coronary artery disease, over 25% of patients discontinued drug therapy within 6 months. Another study of patients receiving statin drugs found that while adherence was nearly 80% in the first three months of treatment, adherence dropped to 56% within 6 months; only one in four patients had an adherence level of 80% or greater after five years.
And different medications may have their own set of problems. For instance, in a study published this month in Population Health Management, many patients prescribed opioids for chronic pain were unlikely to be taking their medicine as prescribed.
Among 938,586 urine toxicology tests conducted on over 500,000 patients prescribed chronic opioid therapy, analysis showed that 38% of patients had no detectable level of their prescribed medications; 27% had a drug level higher than expected; 15% had a drug level lower than expected; 11% had major illicit drugs such as cocaine or methamphetamines detected in their urine; and 29% had a medication in their system that the doctor was likely unaware of.
While nonuse does not necessarily indicate misuse, this information does "indicate that something needs to looked into further" by providers when detecting noncompliance among patients, said Harry Leider, MD, chief medical officer of Ameritox, a company that performs urine screenings, and one of the study investigators.
In terms of population groups, the study confirmed previously reported findings that inappropriate use of prescribed medication spans all demographic groups, although in this study, men were significantly more likely to have an illicit drug detected than females.
In these instances, monitoring could be a "critical tool" that physicians could use in combination with "clinical expertise, intuition and their knowledge of each patient's history" to talk with patients about the proper use of medications and ultimately improve outcomes for patients with chronic pain, Leider said.
So where else to look when it comes to appropriate medication use and compliance? NEHI and analysts from Avalere Health interviewed experts and examined 34 adherence programs in the field. The interviews revealed that adherence can be improved using solutions that fall within three pillars:
Improve drug regimen. This means following up with patients, making recommendations or changes when necessary, understanding patient preferences and experiences, and creating accurate medication use profiles.
Reduce cost barriers. This calls for examining value based insurance design plans to lower employee contributions and out of pocket costs for cost-effective medications for chronic disease, identifying prescription assistance programs, and using generics.
Address patient behavior. This calls for engaging patients in the care process, educating patients about their conditions and why they should take their medications, and addressing patient preferences, limitations, and priorities.
