Archive for the ‘Prescription Drugs’ Category

Health Insurers Must Provide “Plain English” Summaries of Benefits, Coverage

February 13th, 2012 by Cheryl Miller

Transparency and clarity are the objectives in HHS’s “Plain English” ruling on health plan benefits and coverage. Under the rule, health insurers must provide consumers with simple, understandable summaries about their plans. Roughly 150 million Americans have private health insurance today, and should benefit from the ruling. More on this in our feature story.

Transparency is also a key objective in CMS’s new data for its Hospital Compare Web site consumers can now access hospital infection rates at the more than 4700 hospitals listed. According to the CMS, hospital-acquired infections result in thousands of deaths each year and nearly $700 million in added costs to the U.S. healthcare system.

Healthcare costs are key to a recent study from Virginia Commonwealth University, which finds that the managed care medical home for the uninsured will help curb costs and reduce ER visits for the uninsured. The study, which focused on nearly 27,000 uninsured adults over a seven-year period, found that when they had access to regular healthcare their ED visits and inpatient admissions declined, while their primary care visits increased. Researchers concluded that savings in healthcare costs were cut by nearly half.

And lastly, costs are also key to a recent Rand Corporation study on declining prescription drug costs. While costs on brand name drugs have decreased because of increased purchases of generic drugs, drug costs in general remain a hardship for many American families.

3 Ways Proposed CMS Rule Could Cut Costs, Increase Transparency in Medicaid Prescription Drug Pricing

February 6th, 2012 by Cheryl Miller

In an attempt to pare down the nearly $16 billion Medicaid spent on prescription drugs in 2009, CMS is proposing three cost-cutting measures, one of which includes increasing rebates paid by drug manufacturers that participate in Medicaid. All of the measures are intended to increase transparency for states and taxpayers as well. The comment period for the proposed rule will close on April 2nd. CMS plans to issue a final rule in 2013.

Cutting healthcare costs is the NQF’s goal also; they are targeting diabetes, CV disease and primary care costs with four new resource use measures which have been approved for endorsement. This is the NQF’s first effort at endorsing measures that evaluate how resources are used in care delivery.

Aetna has launched a national PCMH program that will reward primary care physicians on a quarterly basis for selected care coordinated tasks, as long as the PCPs meet eligibility requirements. Connecticut and New Jersey are the first states to host this program. Aetna is the latest private payor to revamp the medical home funding model; you can read more about the others in our featured blog in this issue.

Hospitals are doing something right: according to the latest study from Press Ganey hospitals’ overall patient satisfaction scores have improved since July 2011, when the value-based purchasing period began. The new VBP criteria will affect hospitals’ performance-based Medicare payments.

P.S. By the time this newsletter publishes Monday, let’s hope the Giants did something right Sunday night and won the Super Bowl. Go Giants!

IOM Suggests 8 Free Preventive Health Services for Women

July 25th, 2011 by Cheryl Miller

Women of all ages and backgrounds will benefit if eight new free preventive health services are added to the Patient Protection and Affordable Care Act (PPACA) of 2010. Birth control, gestational diabetes screening, DNA testing for cervical cancer and domestic violence counseling are among the recommendations in a new report from the Institute of Medicine (IOM).

Low health literacy results in more frequent hospitalizations and a higher risk of death, according to a recent study from RTI International-University of North Carolina. The study found that 77 million English-speaking adults in the United States are unable to understand and use basic health information. Limited health literacy rates are higher among seniors, minorities, lower-income Americans and those with less than a high school education.

In merger news this past week, Express Scripts and Medco agreed to a $29 billion merger deal. Healthcare consumers and the nation’s drug stores will be watching the impact of the merger closely. These stories and more in this week’s Healthcare Business Weekly Update.

One Third of Medical Homes Will Join an ACO

July 18th, 2011 by Cheryl Miller

New market research shows that one third of medical homes will join an ACO in the next 12 months. And more than half of those interviewed by the Healthcare Intelligence Network for our fifth annual survey on patient-centered medical homes said they had already established a medical home for their population. The PCMH is a favored model of integrated care delivery and a cornerstone of accountable care — two core elements of healthcare reform. More in this issue.

About $216 million nationally is spent each year managing drug
shortages in the hospital setting, with three drugs in particular
affecting over 80 percent of health systems, says a new study
released by the American Society of Health-System Pharmacists
(ASHP). The problem is not only increasing hospital costs but
harming patient care: nearly a third of the 353 pharmacy directors
surveyed said they had to pull clinical staff to manage the crisis.

More than $300 billion each year is spent on care for dual-eligibles,
the 9 million Americans currently receiving both Medicare and
Medicaid benefits. HHS hopes to lower these costs — and improve
care — with three new initiatives: financial models to better align
finances between the agencies; a quality care program for nursing
home residents, and a resource center program.

Telemedicine continues to serve the underserved. A new remote
monitoring pilot project from the University of Utah seeks to help the
chronically ill who are unable to reach traditional care facilities easily
on a regular basis. The project will feature a centralized care
coordinator, four clinics monitoring 15 to 20 patients each and two
locations using kiosks to monitor another 30 patients each. Read more in this week’s Healthcare Business Weekly Update.

24 Ways to Avoid Harmful Prescribing

June 20th, 2011 by Jessica Papay

A new article published online in the Archives of Internal Medicine series Less is More entitled “Principles of Conservative Prescribing” outlines 24 principles for prescribers to learn and practice to avoid many of the pitfalls leading to excessive and harmful prescribing:

  • Think beyond drugs: Consider and learn how to better prescribe non-drug therapies such as diet, exercise or physical therapy; look for and treat underlying causes rather than just masking symptoms with drugs, emphasize prevention rather than just treatment.
  • Practice more strategic prescribing: Defer drug treatment if drugs can be safely started after a trial of non-drug therapy; avoid frequent and unwarranted drug switching; being circumspect about unproven drug uses; start treatment with only one new drug at a time.
  • Maintain heightened vigilance regarding adverse effects: Suspect drug reactions when patients report problems while taking a medication; be aware of drug withdrawal syndromes; educate patients about side effects so they can anticipate and report reactions.
  • Exercise caution and skepticism regarding new drugs: Seek out unbiased information sources; wait until drugs have sufficient time on the market to be proven to be safe; be skeptical about surrogate markers of benefit (such as improving a lab test) rather than true clinical outcomes benefit; avoid stretching indications to include patients or diseases different than those in the clinical trials; avoid seduction by elegant molecular pharmacology without proven outcome benefits; beware of selective drug trial reporting that highlights the positive trials and hides those that fail to show benefit.
  • Work with patients for a shared agenda: Do not automatically accede to patient requests for drugs they have heard advertised, consider non-adherence before adding additional drugs; avoid restarting previously unsuccessful drug treatments; discontinue any medications that are not needed or not working; and respect patients’ own reservations about drugs.
  • Consider long-term, broader impacts: Weigh not just the short term benefits but also long-term patient outcomes and ecologic impacts, recognize that improved prescribing systems and better monitoring of patients on medications may outweigh marginal benefits of new drugs.

The concept of “conservative prescribing,” also referred to as more judicious, rational, cautious, or skeptical prescribing, embodies lessons from recent studies demonstrating that many medications are inappropriately used and at times are associated with significant harm. The 24 lessons suggest the need to more thoughtfully weigh claims for drugs, especially new drugs. The principles also draw upon an important construct from ecological thinking — the precautionary principle — which stresses the need to anticipate potential adverse effects, even when cause-and-effect relationships are not fully established. It urges prescribers to err on the side of precaution when uncertain about long term impacts.

How Diabetes Patients Can See a Decrease in Medical Costs

April 1st, 2011 by Jessica Papay

Could diabetes patients decrease their medical costs if they are more medication adherent? Read this week’s issue of the DM Update to find out, and also learn if patients with high-deductible health plans use fewer preventive care services.

Does Medicare Cover for Recommended Prevention Services?

January 31st, 2011 by Jessica Papay

A recent study has found that Medicare may not cover all preventive services. Read this week’s issue of the DM Update to find out more about this coverage gap. Also, we present new data on heart patients and the effect of an obese patient’s race on counseling sessions with physicians.

IT During Care Transitions Can Curb Readmissions

September 28th, 2010 by Patricia Donovan

The use of devices during post-acute care transitions that remind patients to take meds, store prescription data and monitor patients remotely has the potential to reduce hospital readmissions, according to a new Center of Technology and Aging report featured in this month’s issue of ReadmissionsRx. Also this month, Sutter Health’s case management director describes Sutter’s approach to medication reconciliation, and Melanie Matthews, HIN’s executive VP and COO, shares the latest market metrics on reducing avoidable ER use — much of which is attributed to patients recently discharged from the hospital.

Haven’t taken our second annual telehealth survey yet? Respond by September 30 and you will be e-mailed a summary of the compiled results. Learn how more than 100 healthcare companies are using telehealth in clinical and non-clinical areas. For example, 56 percent of respondents thus far monitor patients remotely.

Using Narcotics Contracts to Manage ED High Utilizers

September 27th, 2010 by Jessica Papay

Sara Tracy, senior manager of emergency services at Kaiser Foundation Health Plan of Colorado, describes a formula for identifying high utilizers of the ED.

Resource intensive members — they have also been called “frequent fliers” — are classified as our high utilizers. High utilizers are members who are identified as low, medium or high. Our low members are those that had two ED visits in three months, our medium were those that had either three, four or five visits in six months and our ultra-high utilizers were those that had six or more visits in a year. We did a data pull based on claims data that helped to identify those that had a connection with either chemical dependency, behavioral health or no connection at all. Our data pull included information on the primary care physician (PCP), the EDs they’ve visited including the dates and the diagnosis, the top prescriptions that were prescribed for the member and the dollars that were spent on these members.

We identified approximately 1,000 members that fall within these guidelines. The first group we looked at was those individuals that have a known association with chemical dependency. Those are members who have had a referral or a visit with someone in our chemical dependency department within the last year. Many, if not most, of these members were patients who had issues with narcotics. We pulled a chart review of 25 members to identify those that had a current narcotics contract — an agreement between the physician that’s prescribing the narcotics and the patient on the parameters for the prescription. Often, these members would request early refills; they may show up to the ED in pain requesting IV narcotics, so the narcotics contract is very critical to helping keep these members compliant. In our review, we found that only 20 percent of that population had a contract. When these members subsequently show up in the ED and there’s no contract, the ED does not have much guidance in how to treat this member.

We reviewed our current narcotic contract format and decided that it was very lengthy, rather robust and not user-friendly. We have worked with our chemical dependency department to revise that contract so that it is a one-page contract. It is very succinct and it includes 10 bullet points that the member initials, and it has all the parameters under which the physician will prescribe narcotics for that patient.

Asthma Treatment Trends

September 23rd, 2010 by Jessica Papay

In this week’s Disease Management Update, we focus on asthma medication and management. Find out if asthma medication can benefit MS patients as well as if pediatricians are using recommended methods of diagnosing and managing asthma in children.

And have childhood immunization rates increased or decreased? Get the answer in this issue.