Disease Management Update
Volume IV, No. 48
March 27, 2008

Dear Healthcare Intelligence Network Client,

With March rapidly coming to an end, it is important to note that April marks Parkinson's disease (PD) Awareness Month. Many organizations are holding walks and other events to spread the word and raise awareness for the disease. This week's Disease Management Update also sheds some light on PD, including new research involving therapeutic cloning that has been used to treat mice wth PD, and a gene linked to development of PD in those with family history of the disease.

Your colleague in the business of healthcare,
Laura M. Greene
Editor, Disease Management Update

If this is a forwarded copy of Disease Management Update and you like what you see, you can register to receive your own copy of this complimentary service. Sign up at:

Table of Contents

  1. Therapeutic Cloning Treats Parkinson's Disease in Mice
  2. Disease Management Q&A: Funding Medical Homes and Implementing Measures
  3. HealthSounds Podcast: Building an Advanced Medical Home to Improve Chronic Care Outcomes
  4. Researchers Identify Gene Linked to Development of Parkinson's Disease in Those with Family History
  5. Survey of the Month: Pain Management in Healthcare and the Workplace
  6. Medical Homes: Awareness and Early Successes

1. Therapeutic Cloning Treats Parkinson's Disease in Mice

Research led by investigators at Memorial Sloan-Kettering Cancer Center (MSKCC) has shown that therapeutic cloning, also known as somatic-cell nuclear transfer (SCNT), can be used to treat Parkinson's disease (PD) in mice. The new study shows that therapeutic cloning can treat PD in a mouse model. The scientists used skin cells from the tail of the animal to generate customized or autologous dopamine neurons — the missing neurons in PD. The mice that received neurons derived from individually matched stem cell lines exhibited neurological improvement. But when these neurons were grafted into mice that did not genetically match the transplanted cells, the cells did not survive well and the mice did not recover.

In therapeutic cloning or SCNT, the nucleus of a somatic cell from a donor subject is inserted into an egg from which the nucleus has been removed. This cell then develops into a blastocyst from which embryonic stem cells can be harvested and differentiated for therapeutic purposes. As the genetic information in the resulting stem cells comes from the donor subject, therapeutic cloning or SCNT would yield subject-specific cells that are spared by the immune system after transplantation.

To learn more about this study, please visit:

2. Disease Management Q&A: Funding Medical Homes and Implementing Measures

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's experts are Dr. George Rust, senior consultant for APS Healthcare, interim director of the National Center for Primary Care at Morehouse School of Medicine, and Elizabeth Reardon, a consultant with Commonwealth Medicine in Massachusetts.

Question: How can a health plan fund the transition to a more chronic care medical home model? Also, to ensure that the transition results in improved care, what measures would go along with that?

Response: (Dr. George Rust) There are lots of different options here. Capitate payments can sometimes offer the opportunity to have a more multidisciplinary team involved in care. If you’re in a purely fee-for-service environment, broaden your teams so that nurse practitioners, mental health professionals and behavioral healthcare specialists are all part of the team. In our state, we found that many of our community health centers believed that they could not have two visits by different providers billed on the same day out of the same facility. For example, they could not co-locate psychologists and primary care clinicians in the building on the same day. That turned out to not be true. Those types of visits would indeed be paid for.

Therefore, the first step would be determining how to broaden the team so that it isn’t just a doctor-centered model, but includes individuals who currently may not be in the practice like nurse practitioners, psychologists and behaviorists. This is especially important in the high disparity or multi-cultural communities. Community health workers — people who are of the culture that you’re trying to serve — are important. They’re even more important if your own providers do not match that culture, since they can act as a cultural bridge or ambassador to the community to champion certain outcomes.

The kinds of outcomes to look for are fairly easy to measure, but the more internal electronic systems you have, the easier it is to make your case. In other words, if you can show improvements in A1C, for every point that you lower that A1C level, there is a measurable economic to whomever the payer is on that client. For example, significant reductions in cost are related to a one-point reduction in the A1C. If you look at people with multiple risk factor clusters such as metabolic syndrome, high cholesterol, obesity, hypertension, diabetes and pre-diabetes, approximately 10 percent to 15 percent of those individuals have all their risk factors currently controlled. The opportunity to measure that and then show significant improvement would be low hanging fruit. Group visits are another way to address the issue of how to more effectively address chronic illness in a primary care setting. Many payers will now pay for group visit activities in a way that can be more efficient for your provider, nursing staff and the educators you might bring in for those programs.

(Elizabeth Reardon) There are some CPT evaluation and management codes that address care coordination and treatment planning. They even have some that involve telephone contact. Not all payers want to pay for that. However, it gives you some background. Also, the CPT behavioral management codes that Medicare pays can help. Some of them relate to care planning and some to practice teams getting together to address what they need to work on. A good resource for measures is a collaborative at the Web site http://www.collaborativeselfmanagement.org. This is a pilot project of Robert Wood Johnson and the Health Research and Educational Trust. Dr. Dorianne Miller is one of the gurus of self-management support. She’s developed a good model in working with patients and measures. Lastly, if you’re working in a federally qualified health center (FQHC) or community health center, the type of encounter rate format they use for reimbursement provides a fair amount of flexibility.

For more details on moving toward the advanced medical home model, please visit:

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

3. HealthSounds Podcast: Building an Advanced Medical Home to Improve Chronic Care Outcomes

In this week's disease management podcast, Dr. Lonnie Fuller, medical director for the Pennsylvania Medicaid ACCESS Plus Primary Care Case Management and Disease Management (PCCM-DM) program, and Dawn Bazarko, UnitedHealthcare's senior vice president of clinical innovation, examine medical home projects in action.

To listen to this complimentary HIN podcast, please visit:

4. Researchers Identify Gene Linked to Development of Parkinson's Disease in Those with Family History

Researchers have discovered a gene that could hold the key to developing new treatments for Parkinson's disease (PD). According to the findings of the study, mutations in the gene known as GIGYF2 appear to be directly linked to the development of PD in people with a family history of the disease. The gene is one of only a handful linked to PD and one of just two genes known to be a common contributor to this degenerative disease, which has no known cause or cure.

Although less than a quarter of all cases of PD are familial, researchers believe genes like GIGYF2 can provide clues to the mechanisms behind PD and could point to new treatments for the more common and sporadic forms of the disease. Their research also revealed an intriguing secondary finding — the possible association between PD and insulin and the related hormone known as insulin-like growth factor (IGF). This joins a small but growing body of research linking insulin and IGF to PD and other neurodegenerative disorders, such as Alzheimer's disease.

To see more about this study's results, please visit:

5. Survey of the Month: Pain Management in Healthcare and the Workplace

Complete our online survey on pain management in healthcare and the workplace by March 31, and you'll get a free executive summary of the compiled results.

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

6. Medical Homes: Awareness and Early Successes

Early pilots of the patient-centered medical home model are making good on the promise of improved outcomes, compliance and care. Get an overview of the medical home concept as well as the highlights from 188 healthcare organization responses to HIN's 2008 non-scientific online survey on the medical home at work.

To download this complimentary white paper, please visit:
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