Suzanne Borgos, a senior consultant with Health Strategies & Solutions, discusses ROI components to consider when picking a tumor-site-specific program for an oncology service line. Hear more at the Service Lines Strategies Virtual Workshop.
Lawmakers experienced fresh anger and skepticism as they fielded questions from constituents worried about changes in the healthcare system. The queries presented to legislators all over the country reflected deep-seated fears, a general suspicion of government and, in some cases, a lack of knowledge on the part of the questioners.
Patients who do not take their medications as prescribed by their physicians are costing the American healthcare system as much as $290 billion annually in avoidable medical spending—or about 13% of total national healthcare expenditures, according to a new report from the nonprofit New England Healthcare Institute (NEHI) in Cambridge, MA.
Overall, an estimated one-third to one-half of all patients in the United States do not take their medications as prescribed by their physicians. These adherence problems are being generated in part by growing numbers of individuals with chronic disease: Adherence rates have been found to be lower among patients with chronic conditions than among those with acute conditions, according to the report, Thinking Outside the Pillbox: A System wide Approach to Improving Patient Medication Adherence for Chronic Disease.
"There are enormous costs to non-adherence," said Valerie Fleishman, NEHI's executive director. "First and foremost are the human costs of poorer health."
Among all patient groups, the risk of hospitalization due to poor health outcomes increases—resulting in higher excess costs. For example, among patients with diabetes, those with lower levels of adherence have nearly twice the total annual healthcare costs of those with high levels of adherence ($16,498 versus $8,886).
"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," Fleishman said. "We believe that adherence needs to be woven into the fabric of the health reform debate in several different ways."
The NEHI report cited several innovations that show promise in dealing with adherence, including improving drug regimens, reducing cost barriers, and tailoring programs to individual patients. From these areas, NEHI identified four of the more promising solutions for public and private policymakers to examine in addressing patient medication adherence as part of health reform efforts:
Creating healthcare teams. While physicians play key roles in improving medication adherence by their patients, the issue could be too complex for physicians alone—leading to calls for additional support through the creation of care teams that incorporate nurses, care managers, pharmacists, and other clinicians. This can be either within or outside a physician’s practice. These teams increase the number of “touchpoints” for patients--providing repeated checks on their adherence as they move through the healthcare system, Fleishman said.
Patient engagement and education. Counseling by primary care providers and pharmacists can ensure that patients understand their diseases and how their medication can improve their condition. This can prove critical to motivating patients toward sustained adherence.
Payment reform. Realigning reimbursement incentives away from rewarding volume and toward rewarding good outcomes could encourage providers to strive for improved outcomes by way of improved adherence, as would performance based or global service reimbursements, the report noted. In the long run, payment reform would encourage providers to invest in resources, such as counseling services, that would improve patient outcomes by increasing medication adherence.
Using health information technologies. More secure and reliable information flows using technologies, such as electronic health records, e prescribing, and clinical decision support systems, could ensure that complete and accurate medication data are shared among patients, prescribing physicians, and pharmacists.
During a town hall meeting in New Hampshire, President Barack Obama slammed talk of euthanasia "death panels" and Medicare cuts, urging supporters to confront the opposition. At President Obama's first town-hall meeting since opponents began roiling such gatherings, questioners worried that a government-sponsored option would overwhelm the private healthcare market, and one participant said he was pushed off his name-brand high-cholesterol medication by Medicaid officials.
The battle for public opinion on a healthcare overhaul appears to be at a stalemate despite conservative activists attending town hall meetings to register their opposition. A new Gallup Poll found that support for President Obama's handling of the issue has stayed status quo over the past three weeks during the protests. In a poll conducted Aug. 6-9, 49% of Americans said they disapproved of the president's handling of healthcare and 43% approved, compared to 50% disapproval and 44% approval in a survey done July 17-19.
California Gov. Arnold Schwarzenegger conceded that long-standing delays in disciplining errant health professionals were "absolutely unacceptable" and promised broad reforms to better protect patients from dentists, pharmacists, therapists, and others accused of misconduct. Among the proposed changes: adding more investigative and legal staff, appointing an official to audit the boards and seeking legislation that would allow quicker suspension of uncooperative or jailed professionals' licenses.
Connecticut officials are calling for major changes in how rate increases are granted on individual health insurance policies. "Consumers must be empowered to stop chronic colossal rate hikes," said Attorney General Richard Blumenthal, who was joined by Kevin P. Lembo, the state healthcare advocate, and lawmakers. The heart of the reforms they're seeking is a rule that rate hikes must be "reasonable," rather than simply "not excessive," as the current rule is written.
The Office of Inspector General (OIG) issued a report on Aug. 7 that said state Medicaid Fraud Control Units (MFCU) recovered $1.3 billion in court-ordered restitution, fines, civil settlements, and penalties for fiscal year 2008.
The report went on to say the MCFUs also obtained 1,314 convictions; achieved 971 civil settlements and/or judgments, and excluded 755 providers from participation in the Medicare, Medicaid, and other Federal health care programs in FY 2008.
According to the report, the mission of the MFCUs is to investigate and prosecute Medicaid provider fraud and patient abuse and neglect. Forty-nine states and the District of Columbia have MFCUs. The only state without an MFCU is North Dakota.
The report highlights a settlement between the New York MFCU and Staten Island University Hospital (SIUH) and SIUH Systems, Inc., in which SIUH agreed to pay the Medicaid program $24.8 million. The settlement resolved allegations that SIUH Systems billed Medicaid for detoxification treatment provided in a special unit of the hospital without a state-issued certificate of operation.
A Dallas-based company with plans for a medical trade center in Nashville has hired the former head of a Vanderbilt-linked think tank as a senior adviser. David Osborn will have responsibility for strategic development of the Nashville Medical Trade Center. Osborn was executive director of the Health Care Solutions Group, a public policy organization created by Vanderbilt University Medical Center and the Nashville Health Care Council.
As debate over his healthcare overhaul heats up, President Obama is taking off for a family vacation that combines with the challenge of trying to sell his ideas to audiences out West. The president plans to hold town halls in Montana and Colorado to address problems facing the healthcare system and pitch Democratic plans to fix them.
