Disease Management Update
Volume III, No. 39
January 18, 2007

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Table of Contents

  1. Not Enough Americans Receiving Screenings, Counsel
  2. Disease Management Q&A: ROI from DM Quality Improvement
  3. HealthSounds Podcast: Healthcare Report Cards: How to Get an A+ in the Public Reporting of Healthcare Quality Data
  4. Limitations in Quality-of-Care Indicators of Heart Failure Patients
  5. Survey of the Month: Preventing Hospital Re-Admissions
  6. Healthcare Report Cards: Hospitals, Health Plans and Consumers Grade the Effort

1. Not Enough Americans Receiving Screenings, Counsel

The overall quality of the U.S. healthcare system is improving, but providers are missing important chances to help Americans avoid disease or serious complications, according to annual reports issued by the Department of Health & Human Services's (HHS) Agency for Healthcare Research and Quality (AHRQ). The 2006 National Healthcare Quality Report and National Healthcare Disparities Report both found that the use of proven prevention strategies lags significantly behind other gains in healthcare.

Only about 52 percent of adults reported receiving recommended colorectal cancer screenings. About 56,000 Americans die from colorectal cancer, and 150,000 new cases are diagnosed each year. In 2002, the AHRQ-supported U.S Preventive Services Task Force urged initial screenings at age 50 and earlier for people at high risk.

Fewer than half of obese adults reported being counseled about diet by a healthcare professional. About one-third of American adults are obese, increasing the risks of high blood pressure, type 2 diabetes, stroke, heart disease and osteoarthritis. The task force recommends "intensive counseling and behavioral interventions" for obese adults.

Only 49 percent of people with asthma said they were told how to change their environment, and 28 percent reported receiving an asthma management plan. Asthma causes about 500,000 hospitalizations annually.

Only 48 percent of adults with diabetes received all three recommended screenings—blood sugar tests, foot exams and eye exams—to prevent disease complications. AHRQ estimates about $2.5 billion could be saved each year by eliminating hospitalizations related to diabetes complications.

To learn more about this report, please visit:

2. Disease Management Q&A: ROI from DM Quality Improvement

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Dr. Milton Schwarz, regional medical director at Aetna US Healthcare.

Question: What is the best ROI methodology on pay-for-performance programs that you have evaluated, and how does it work?

Response: We have demonstrated ROIs in several areas, one in congestive heart failure. Those patients enrolled in our congestive heart failure programs show significant ROI cost savings compared to a cohort of patients not enrolled.

Second, in depression management, we have data to show that for patients enrolled in depression management programs, where we can demonstrate increased compliance of taking antidepressant medicines, there is a huge ROI in that cohort of members in the utilization of medical services, i.e., significant reductions.

Appropriate use of antibiotics and optimal depression management is something that we will incorporate into this collaborative. When we can demonstrate that we can change behavior as a result of incorporating those measures, there is a potential to significantly impact ROI.

For more details on aligning financial incentives with quality-improvement measures, please visit:

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

3. HealthSounds Podcast: Healthcare Report Cards: How to Get an A+ in the Public Reporting of Healthcare Quality Data

In this week's Disease Management podcast, Paul L. Green, director of clinical quality improvement at John F. Kennedy Memorial Hospital, describes the growth of public interest in hospital report cards and whether these report cards truly make a difference among consumers as they select sites of care. Additionally, Christine Profita Orok, project leader of cost and quality at Blue Cross Blue Shield of Massachusetts, defines the goals and principals of her organization's quality reporting program.

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4. Limitations in Quality-of-Care Indicators of Heart Failure Patients

All five standard hospital-based performance measures used to gauge quality of care for hospitalized heart failure patients may not be the best benchmarks, since none were significant predictors of patient mortality during the critical 60 to 90 days immediately following hospital discharge, according to researchers at UCLA.

Published in the Journal of the American Medical Association, the study found that none of the current measures used to assess hospital performance by the Joint Commission on Accreditation of Healthcare Organizations and by the federal government through the Center for Medicare and Medicaid Services were associated with a lower risk of mortality during the days immediately following hospital discharge, when adverse events are most likely to occur.

The five measures, developed by the American College of Cardiology and the American Heart Association, include: (1) Giving complete medical instructions to patients upon hospital discharge; (2) evaluating the heart's left ventricle systolic function; (3) prescribing patients an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) drugs; (4) smoking cessation counseling; and (5) prescribing anticoagulation for atrial fibrillation.

The study determined that none of the five standard measures were significantly associated with reduced early mortality risk and that ACE inhibitor or ARB use only modestly affected mortality or rehospitalization outcomes.

Prescribing a beta-blocker in eligible patients, however, was strongly associated with lower mortality risk and lower death or rehospitalization risk. Only the American Heart Association's Get with the Guidelines–Heart Failure program, one of the national quality improvement programs for heart failure, routinely collects and reports on a beta-blocker performance measure for patients hospitalized with heart failure.

To see more of this study's findings, please visit:

5. Survey of the Month: Preventing Hospital Re-Admissions

Is your organization targeting hospital re-admissions? What risk factors do you target? What strategies are you employing, and which are finding the greatest success? Complete our survey and you'll receive a free executive summary of the compiled results.

To participate in this survey and receive its results, please visit:

6. Healthcare Report Cards: Hospitals, Health Plans and Consumers Grade the Effort

With more health plans, hospitals and providers publishing quality and performance ratings, discriminating consumers can evaluate a doctor or care center the same way they comparison-shop for cars and electronics. While the reporting of healthcare quality data is mostly voluntary for now, health plans, employers, consumers and even the federal government are leaning on healthcare providers to document the quality of the care they provide. The emerging trend among plans and payors, including the Centers for Medicare and Medicaid Services, is to align financial incentives with improved results. The hope is that this strategy will enhance healthcare quality without increasing costs.

In a recent online survey, the Healthcare Intelligence Network polled hospitals and health plans on their performance data publishing practices and asked consumers to rate industry efforts.

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