Disease Management Update
Volume III, No. 43
February 15, 2007

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Table of Contents

  1. Disparities in Colon Cancer Screening Among Medicare Patients
  2. Disease Management Q&A: Disease Management Q&A: Assessing Risk in the Medicare Population
  3. HealthSounds Podcast: Managing Transitions to Care for the Dually Eligible Medicare and Medicaid Patient
  4. Vision Loss's Costly Corrolary Conditions
  5. Baby Boomers' Impact on Healthcare: High Demands, Expectations Met with a Healthy Dose of Prevention

1. Disparities in Colon Cancer Screening Among Medicare Patients

Although Medicare coverage for colorectal cancer screening has increased, there are still significant disparities in screening practices by ethnicity, sex, age, education and income level, according to a report in the Archives of Internal Medicine.

Researchers examined the Medicare physician billing claims file for New York, Florida and Illinois for 2002 and 2003 to identify the rates of colon cancer screening tests in the population at average risk for the disease. A total of 596,470 Medicare recipients were included in the study population; an estimated 18.3 percent had been screened for colon cancer during the study period.

"Blacks (9.7 percent) and Hispanics (8.1 percent) had lower rates of colon cancer screening compared with whites (19.3 percent)," the authors note. "Individuals living in ZIP codes with a higher per capita income were more likely to undergo a colon screening test than were those living in ZIP codes with a lower per capita income (21 percent and 14.6 percent in the highest and lowest tertiles respectively)." The study also found that women were less likely to undergo an invasive screening test or colonoscopy and that residing in a ZIP code with a greater amount of high school graduates was associated with undergoing colon cancer screening.

"Despite expanded Medicare coverage, there are still significant disparities in colorectal cancer screening practices," the authors conclude. "Further research is needed to determine the basis for the observed ongoing disparities to develop interventions to reduce and eliminate these differences."

To learn more about this report, please visit::

2. Disease Management Q&A: Assessing Risk in the Medicare Population

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Dr. Randall S. Krakauer, national medical director of retiree markets at Aetna, Inc.

Question: How can an HRA effectively identify risk in the Medicare population?

Response: When working with Medicare, the most important component of the HRA is its completion rate. We have intense outreach programs targeted to various Medicare demographics, and our HRA has a high rate of completion, by industry standards. A basic strategy is to keep your HRA simple. Limit the number of questions and make it available at members' convenience — through mail, telephone, etc. Complex assessments inhibit effectiveness because members are not motivated to take the time to be thorough.

Also, it is extremely valuable to get the HRA information early. If you have a high completion rate, try to get the data in quickly so you can target new members as soon as they show up on your list. That's when they're most willing to take time and give accurate information. Whatever your strategy, the completion rate will tell you whether or not it's effective. For example, if only 50 percent of your members complete the HRA, you're probably going to have to refine your process. Some of the high-risk cases you most want to reach will be lost in that 50 percent that does not respond. I suggest a simple HRA, aggressive outreach and early identification. It's more important that you're alert to new cases than that you analyze them inside and out. You've got to keep the wheel moving.

For more details on identifying risk, improving predictive modeling techniques, and implementing strategies for enrollment and engagement of Medicare beneficiaries, please visit:

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

3. HealthSounds Podcast: Managing Transitions to Care for the Dually Eligible Medicare and Medicaid Patient

Beyond the issues one might expect from serving the dual-eligible population, Minnesota Senior Health Options' (MSHO) program also addresses the service barriers that occur in a rural setting. In this week's Disease Management podcast, Sarah Keenan, clinical liaison with Medica, describes how MSHO responds to these service issues and how the inevitable breakdowns during care transitions are managed through MSHO's "care coordination" efforts, which ensure communication between providers and follow a patient seamlessly through transitions of care.

The flexibility inherent in MassHealth's Senior Care Options model empowers providers to offer on-site and community-based care to enrollees, improves the level of service offered to diverse populations and offers participants a seamless transition to the Medicare part D benefits. Diane Flanders, director of coordinated care systems for MassHealth, provides an overview of the unique partnership that is designed to keep its seniors as well as possible, and in their homes and communities for as long as possible.

To listen to this complimentary HIN podcast, please visit:

4. Vision Loss's Costly Corrolary Conditions

Medicare beneficiaries with coded diagnoses of vision loss incur significantly higher costs than those with normal vision, and approximately 90 percent of those costs are non-eye related, according to a study published in the journal Ophthalmology.

As a result, the American Academy of Ophthalmology is calling for Medicare and other medical insurance plans to place a stronger emphasis on providing preventive eye care for all Americans.

Researchers looked at a 5 percent sampling of all Medicare beneficiaries continuously enrolled from 1999 to 2003 and concluded that those with moderate, severe and total vision loss experienced increases in depression, injuries and the need for nursing home facilities.

According to the study, those with moderate loss, severe loss and blindness had annual non-eye related costs of $2,193, $3,301 and $4,443 more than those with normal vision.

More than half of the cases were due to age-related macular degeneration and glaucoma. A sizable number of cases of vision loss were due to cataracts that had not been surgically removed.

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

5. Baby Boomers' Impact on Healthcare: High Demands, Expectations Met with a Healthy Dose of Prevention

Baby boomers are depicted as an educated, financially secure bunch, redefining retirement as they care for aging parents and launch second careers. But whatever else they accomplish during their "golden years," baby boomers will likely fall ill and challenge the healthcare system to treat and manage their chronic and acute health conditions — by 2029, when all of the baby boomers in the United States have turned 65 years of age, some experts predict we'll be in the midst of a dementia epidemic.

In a recent online survey, the Healthcare Intelligence Network asked healthcare organizations to assess baby boomers' impact on their field and define strategies for anticipating and treating the needs of the sandwich generation so consumed with caring for their own parents that they may neglect their personal health issues.

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