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March 24, 2011 Volume VII, No. 37

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

This week's issue looks at newer, expensive cancer treatments being adopted by Medicare patients, along with the effect of stem cell treatment on MS patients.

Also this week, learn which online behavior was ignited by the 2009 cigarette excise taxes.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Medicare Use of Expensive Prostate Cancer Treatments
  2. MS & Stem Cell Treatment
  3. Shared Savings in the Medical Home
  4. Selecting Chronic Conditions for NCQA Tracking
  5. 5 Organization Types Eligible To Be ACOs
  6. 2010 Benchmarks in HRA Use
  7. Smoking Cessation & Cigarette Taxes
  8. Health & Wellness Incentives Use in 2011

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Use of Newer, More Expensive Prostate Cancer Treatments Increasing

Newer, more expensive treatment options for prostate cancer were adopted rapidly and widely during 2002-2005 without proof of their cost-effectiveness, and may offer explanations for why healthcare spending accounts for 17 percent of the nation's GDP, according to research from the Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC). With 180,000 men diagnosed with prostate cancer each year, it is one of the most common types of cancer in the country. For this reason, it has been cited as a good marker for healthcare spending in general, reflective of the greater trends across the United States.

Researchers evaluated the use and cost of surgical and radiation treatments for prostate cancer using Medicare linked data from more than 45,000 men who were 65 years or older between 2002 and 2005. The data accounted for patients who received two types of surgical treatments: the older treatment, which is open radical prostatectomy, and the newer treatment, which is robot-assisted or laparoscopic prostatectomy; and two types of radiation treatments: the older type, which is three-dimensional conformal radiation therapy (3D-CRT), and the newer option, which is intensity-modulated radiation therapy (IMRT).

Researchers report that among surgical patients, the number who received robot-assisted or laparoscopic prostatectomy increased substantially from 1.5 percent of diagnoses in 2002 to 28.7 percent of diagnoses in 2005. Among patients who received radiation therapy, researchers observed the same trend towards rapid adoption of IMRT. In 2002, 28.7 percent of men diagnosed received IMRT compared to 81.7 percent in 2005. Additionally, among men who received brachytherapy, supplemental IMRT increased from 8.5 percent in 2002 to 31.1 percent in 2005. Patients receiving the newer type of therapy tended to live in higher-income and metropolitan regions, and were more likely to have earlier stage disease and be of Asian descent.

Researchers also report that Medicare spending on the newer treatment options was significantly higher than on traditional treatments, with the difference between IMRT and 3D-CRT being nearly $11,000 per patient and the difference between robot-assisted prostatectomy and open radical prostatectomy being $293, although the authors suggest that this is an underestimate of the underlying cost differences in the surgeries since it does not account for the cost of purchasing and maintaining the robot. After extrapolating these numbers to the total U.S. population, researchers report an additional of spending adding up to nearly $350 million in 2005 on newer treatment options when compared to the traditional and less costly alternative therapy for men diagnosed with prostate cancer.

To learn more about this research, please visit:

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Could Stem Cells Show Promise for People with Rapidly Progressing MS?

Replacing bone marrow purposely destroyed by chemotherapy with autologous (self) stem cells, could help treat people with aggressive forms of multiple sclerosis (MS), according to a long-term study by the American Academy of Neurology. For the treatment, chemotherapy drugs are used to kill all of the patient’s blood cells, including the immune cells that are believed to be attacking the body’s own central nervous system. Bone marrow stem cells removed from the patient are purified and transplanted back into the body, which saves life by replacing the blood cells and is also proposed to ‘reboot’ the immune system.

The study followed 35 people for an average of 11 years after transplant. The study involved people with rapidly progressive MS who had tried a number of other treatments for MS with little or no effect. All were severely disabled by the disease, with an average score of 6 on a scale of disease activity that ranges from 0 being a normal neurological examination to 10 meaning death due to MS. A score of 6 means able to walk with a cane or crutch; a 7 is mainly in a wheelchair. All had worsened by at least one point on the scale in the year prior to the transplant.

After the transplants, the probability of participants having no worsening of their disease for 15 years was 25 percent. The probability was higher — 44 percent — for those who had active brain lesions, which are a sign of disease activity, at the time of the transplant. For 16 people, symptoms improved by an average of one point on the scale after the transplant, and the improvements lasted for an average of two years. The participants also had a reduction in the number and size of lesions in their brains. Two people (6 percent) died from complications related to the transplant at two months and 2.5 years post-transplant.

Study authors noted that more research is needed on this treatment, including studies that compare people receiving the treatment to a control group that does not receive the treatment. “Keeping that in mind, our feeling is that stem cell transplants may benefit people with rapidly progressive MS. This is not a therapy for the general population of people with MS but should be reserved for aggressive cases that are still in the inflammatory phase of the disease,” said the study authors.

To learn more about this research, please visit:

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Shared Savings in the Medical Home

The patient-centered medical home is at the heart of Mesa County, Colorado's shared savings model, explains David West, M.D., a hospitalist, family physician and healthcare consultant from Grand Junction, Colorado. Dr. West describes how the shared savings model can be adapted across markets, including the conditions and factors that must be present for this approach to be feasible. He also shares a unique provider incentive that is keeping hospital stays of Medicare patients at less than one-third the national average, one of the factors that has the nation touting this area as a model for efficient healthcare delivery.

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Selecting Chronic Conditions for NCQA Tracking

This week's expert is Barbara Luskin, quality manager of Grand Valley Health Plan.

Question: How did you select three chronic conditions for NCQA tracking and patient-centered medical home recognition?

Response: We looked at all the standards that require the use of the chronic conditions. We tried to pick chronic conditions that we were comfortable with that would meet the majority of those standards. There are many different ones that overlap. For example, when thinking about a standard like diabetes, you must decide if it is going to fit for 2D, 2E, 3A, 3D, 4B and 9C. If you are pretty sure, then that is a good one to use. If not, then it’s probably not the best one to use. The NCQA asks you to run some data right off the bat to determine your highest volume and suggest that you use those. For us, our highest volume was our diabetic population, so that was the program we used and it fit with other standards.

For more information on NCQA tracking and PCMH recognition of chronic conditions, please visit:

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5 Organization Types Eligible To Be ACOs

The healthcare reform law provides for accountable care organizations (ACOs), a group of healthcare providers that agrees to be accountable for the quality, cost and overall care of assigned Medicare beneficiaries. We wanted to see the five types of organizations eligible to be ACOs under the CMS Shared Savings Program.

Click here to view the table.

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2010 Benchmarks in Health Risk Assessment Use

This white paper captures trends in the use of aggregate data from health risk assessments (HRAs) by 116 healthcare organizations to design and deliver health promotion and disease management interventions to targeted individuals in response to the Healthcare Intelligence Network June 2010 Health Risk Assessments e-survey.

To download this complimentary white paper, please visit:

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Cigarette Tax Ignites Online Reactions from Smokers

The 2009 U.S. federal cigarette excise tax increase successfully drove many smokers online to find ways to quit smoking, but more often smokers responded by shopping online for tax-free or cheap cigarettes in an apparent effort to evade the tax hike, according to an analysis of Internet search data. A study by Johns Hopkins Bloomberg School of Public Health evaluated smokers’ responses to the federal cigarette excise tax, which increased from $0.39 to $1.01 per pack under the State Children's Health Insurance Program (SCHIP) reforms.

For the study, researchers studied the impacts of the SCHIP tax increase by monitoring search queries to Google-powered search engines a year before and after the SCHIP tax increase. The researchers found that, around the time the SCHIP tax increase took effect, smoking cessation and tax avoidance search queries reached new highs, increasing about 50 percent and 300 percent over baseline, respectively. However, cessation searches approximated pre-tax levels within two weeks of the tax, while searches for tax-free and cheap cigarettes remained about 60 percent higher a year after the tax. Analyses of search trends for two recent state-specific cigarette excise tax increases in Florida and New York corroborated these trends.

“Health professionals need to anticipate how the public may respond to changes in health policies or new health information. We can create new approaches for utilizing Internet searches to help the public make the best decisions to improve their health,” said Daniel Ford, MD, vice dean of clinical investigation for Johns Hopkins Medicine. “It has been a challenge to find ways to engage smokers who are not actively considering quitting. When policies lead to increased Internet searches for cheap cigarettes, this might provide an important opportunity for reaching these smokers,” added Dr. Ford.

To learn more about this research, please visit:

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Health & Wellness Incentives Use in 2011

Healthcare companies have grown increasingly creative in their use of incentives to drive engagement and participation in health and wellness programs. Join the more than 120 healthcare companies that have shared their experiences with incentives by completing HIN's third annual survey on this topic by March 31, 2011. You'll receive a free executive summary of the compiled results, and your responses will be kept strictly confidential.

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

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