Disease Management Update
Volume III, No. 40
January 25, 2007

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Table of Contents

  1. Repeat Bone Mineral Density Scans Not Helpful for Predicting Fractures
  2. Disease Management Q&A: Prenatal and Birth Toolkits
  3. HealthSounds Podcast / Maternity Disease Management: Assessments, Guidelines and Monitoring to Meet Positive Expectations
  4. Significant Healthcare Costs for Abused Women
  5. Survey of the Month: Preventing Hospital Re-Admissions
  6. The Healthcare Industry's Response to the Uninsured: Organizations Take Steps to Counter Financial Impact

1. Repeat Bone Mineral Density Scans Not Helpful for Predicting Fractures

Repeating a bone mineral density (BMD) scan up to eight years after an initial BMD appears to provide little additional benefit for predicting fractures among older postmenopausal women, according to a report in Archives of Internal Medicine.

Current guidelines recommend screening all women for osteoporosis using BMD measurements at age 65. There is little evidence supporting the use of repeat BMD testing for evaluating fracture risk, but such additional tests are commonly performed in clinical practice.

Researchers measured total hip BMD in 4,124 older women (average age 72 years) in the Study of Osteoporotic Fractures between 1989 and 1990 and again an average of eight years later.

"In each of the four BMD models (initial BMD, repeat BMD, change in BMD between the two examinations, and initial BMD plus change in BMD), BMD was a significant predictor of incident non-spine and hip fracture risk, and was associated with morphometric spine fractures," fractures in which the diagnosis is made based on vertebral shape, the authors write.

However, "we did not find any improvement in the overall predictive value... in a second measure of BMD, obtained a mean [average] of eight years later, in prediction of hip, spine or overall non-spine fracture risk," they continue. "In other words, the initial BMD was highly, and similarly, predictive of fracture risk in our population."

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

2. Disease Management Q&A: Prenatal and Birth Toolkits

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Thomas M. Smith, R.N., M.A., director of medical care management at Health Management Corporation (HMC).

Question: What do HMC's prenatal and birth kits include?

Response: Our prenatal kit includes an introduction letter to the new participant as well as a provider assessment. We encourage patients to bring the form to their doctors so we can get professional feedback. Our kit shows members their pregnancy week by week, and includes information on smoking cessation, hydration and nutrition during pregnancy. We usually hold off on postpartum information until the 28th week when we send out our birth options kit.

We're currently redesigning our birth kit, and plan to include a parenting book covering birth through age five. Our kits are comprehensive, providing resources on childrearing, medical and behavioral health, and general postpartum follow-up — geared to keep members healthy during and after pregnancy.

For more details on prototypes for prenatal care; maternity program quality improvement; managing high-risk pregnancy populations; and identifying and preventing postpartum depression, please visit:

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

3. HealthSounds Podcast: Maternity Disease Management: Assessments, Guidelines and Monitoring to Meet Positive Expectations

In this week's Disease Management podcast, Dr. Joseph Stankaitis, a chief medical officer at Monroe Plan for Medical Care, explains how incentives have improved physicians' completion of his organization's prenatal registration form and how Monroe improved coordination between its perinatal staff and behavioral health staff to address mental health and chemical dependency issues in the targeted population. Overcoming barriers to outreach is a crucial component of Health Management Corporation's telephonic Baby Benefits program, says Tom Smith, the organization's director of medical care management. And Christy L. Beaudin, PHD, LCSW, CPHQ, corporate director of quality improvement at PacifiCare Behavioral Health, describes the crucial differences between the "baby blues" and postpartum depression.

To listen to this complimentary HIN podcast, please visit:

4. Significant Healthcare Costs for Abused Women

Women with a history of abuse by intimate partners have significantly higher healthcare costs and utilization than women with no history of such abuse, according to a study conducted at Group Health, a Seattle-based health plan. The higher costs and utilization continued long after the abuse ended, the research team found. The findings appear in the American Journal of Preventive Medicine.

The study was based on telephone surveys, medical records, and utilization data from 3,333 women, aged 18 to 64 years old. Of these, 1,546 women reported having experienced intimate partner violence (IPV) in their lifetime. The study defines IPV as both physical and nonphysical abuse.

The study showed that annual total healthcare costs were 19 percent higher in women with a history of IPV ($439 annually) compared to women without IPV in their backgrounds. Healthcare utilization was higher for all categories of service during and after IPV compared to women who had not been abused. Healthcare utilization was still 20 percent higher five years after women's abuse ceased compared to women who had never experienced IPV.

Women reporting IPV had 17 percent more primary care visits, 14 percent more specialist visits, and 27 percent more prescription refills. They were also more likely to use services in the areas of mental health, substance abuse, hospital outpatient care, emergency department care, and acute inpatient care during and after periods of IPV.

The estimated excess costs to the health plan due to IPV are approximately $19.3 million per year for every 100,000 women enrollees aged 18 to 64. This estimate is based on prevalence for IPV of 44 percent — a figure established in a study the Group Health/UW team published in 2005.

To learn more about this study, 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. The Healthcare Industry's Response to the Uninsured: Organizations Take Steps to Counter Financial Impact

With the number of uninsured Americans having reached an all-time high as of 2005 — at a record-breaking 15.9 percent — the entire healthcare industry is feeling the impact. It is a problem caught in an unending cycle: because of the expense of insurance, many employers are reluctant to provide health benefits to their employees, or if they do the premiums are often too steep for employees to afford. This in turn leads to higher healthcare costs as hospitals and federal assistance programs are increasingly called upon to cover the costs of patients who are simply unable to pay for their healthcare.

The impact of the uninsured on the costs of insurance coverage will only continue to increase. As more and more uninsured choose to use expensive emergency departments as their primary care, the costs of these visits ends up being borne in part by the hospitals and clinics, leading to an increase in the amount that they subsequently charge private health insurers. It is increasingly being left up to the healthcare industry to find and implement ways to keep their own costs of healthcare down. In a recent online survey, the Healthcare Intelligence Network asked its constituents to discuss the responses of their organizations to the issue of uninsured patients.

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