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March 31, 2011 Volume VII, No. 38

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

Could diabetes patients decrease their medical costs if they are more medication adherent? Read this week's issue to find out, and also learn if patients with high-deductible health plans use fewer preventive care services.

Today is the last day to take our 2011 Health & Wellness Incentives Use survey. Almost 75 percent of respondents are planning to offer incentives for smoking cessation programs in the future. Get more data on incentives use by taking our survey today.

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

This week's DM news:

Table of Contents

  1. Diabetes Medication & Medical Costs
  2. Obese Patients Underestimate True Weight
  3. Hospital & SNF Care Transitions
  4. The Pharmacist & Medication Management
  5. Medical Home Effectiveness
  6. 2011 Benchmarks in ACOs
  7. Preventive Care & High-Deductible Health Plans
  8. Health & Wellness Incentives Use in 2011

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Melanie Matthews, mmatthews@hin.com

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Taking Diabetes Medication Helps Lower Medical Costs

Diabetes patients who do a better job of taking their medication have slightly lower healthcare costs, according to a study from Health Behavior News Service. Researchers followed about 4,000 Medicare patients who had diabetes diagnoses. Researchers asked the patients to track their pill counts and derived estimated spending costs from Medicare data. Their findings conflict with some published data on the correlation between medication adherence and medical savings.

Researchers found that patients who take statin drugs to control cholesterol levels for their diabetes could realize $832 in savings over three years if they increased their medication adherence by 10 percent. The same increase in medication adherence from patients taking ACE inhibitors, a class of antihypertensive drug, was associated with $285 lower Medicare costs over a three-year period. A 10 percentage-point increase is equal to taking three more pills a month if a patient were prescribed one a day for a 30-day month.

Because factors other than medication adherence influence a patient’s health, other outcomes such as overall quality of life are also tough to measure.

To learn more about this research, please visit:

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Obese and Overweight Women, Children Underestimate Their True Weight

Overweight and obese mothers and their children think they weigh less than their actual weight, according to American Heart Association research. In the study of women and children in an urban, predominantly Hispanic population, most normal weight women and children in the study correctly estimated their body weight, but most obese women and children underestimated theirs. The researchers asked the study participants about their age, income, heart disease risk factors, and perceptions of their body size using silhouette images that corresponded to specific BMI types — for example, underweight, normal and overweight. The researchers found that:

  • 65.8 percent of the mothers surveyed were overweight or obese.
  • 38.9 percent of children surveyed were overweight or obese.
  • 81.8 percent of obese women underestimated their weight compared to 42.5 percent of overweight and 13.2 percent of normal weight women; similarly, 86 percent of overweight or obese children underestimated their weight compared to 15 percent of normal weight children.
  • Of mothers with overweight or obese children, almost half (47.5 percent) thought their children were of normal weight.
  • Children selected larger body images than those chosen by their mothers to describe an “ideal” or “healthy” body image for a woman.
  • 41.4 percent of the children in the study thought their moms should lose weight.
According to the researchers, “These findings imply that not only is obesity prevalent in urban America, but that those most affected by it are either unaware or underestimate their true weight. In addition, obesity has become an acceptable norm in some families. Strategies to overcome the obesity epidemic will need to address this barrier to weight loss.” Future research should include interventions that study the effect of increased accuracy of body image perception on weight loss among families.

To learn more about this research, please visit:

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Improving Transitions of Care Between Hospital and SNF: A Collaboration Supporting the Accountable Care Vision

Working with a network of 40 skilled nursing facilities to hone the hospital-to-SNF transfer of care has accomplished two goals for Summa Health System: readmissions and lengths of stay for patients released to SNFs have been reduced, and the experience has made hospitals and SNFs more accountable for both the quality and cost of care they provide. Carolyn Holder, manager of transitional care for Summa Health System, describes what had to happen before this critical care transition could improve and why physicians had to rethink their approach to hospital-to-SNF transfers.

To listen to this complimentary HIN podcast, please visit:

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Including a Pharmacist on the Medication Therapy Management Team

This week's expert is Beth Chester, PharmD, MPH, BCPS, senior director of clinical pharmacy services and quality at Kaiser Permanente Colorado.

Question: What's the relevance of including a pharmacist on a medication therapy management (MTM) team?

Response: MTM services can be performed by non-pharmacists; however, of all the healthcare professionals, pharmacists have the most in-depth training related to medications. Today’s graduates must complete six years of college before they receive their doctor of pharmacy degree, and many go on to complete general or specialty residencies — extensive training that makes the pharmacist the most knowledgeable healthcare professional when it comes to optimizing medication use.

Several studies demonstrate that pharmacists in a variety of practice settings can improve clinical outcomes and sustain these improvements over time. Accrediting organizations such as the NCQA have begun to recognize pharmacists’ expertise when it comes to medication review and reconciliation. Two of the newer HEDIS® metrics — one on medication reconciliation post-discharge and another for medication review in the elderly — only gives health plans credit when these activities are performed by a prescribing practitioner or a clinical pharmacist.

Many organizations think of the pharmacist as the individual standing behind the counter at the local community pharmacy. There are certainly many examples of community pharmacists providing MTM services. For example, the Asheville Project in North Carolina improved asthma and diabetes control and decreased overall medical costs. The Wyoming PharmAssist Program achieved yearly cost savings of approximately $1700 per patient.

For more information on medication therapy management, please visit:

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Top 5 Indicators of Medical Home Effectiveness

The patient-centered medical home can deliver quality care at little or no added cost while improving patient and provider satisfaction. We wanted to see which metrics organizations evaluate to measure the effectiveness of the medical home.

Click here to view the chart.

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2011 Benchmarks in Accountable Care Organizations

A significant segment of the healthcare industry is reframing its care delivery structure as an accountable care organization (ACO) or will do so in the near future, according to new market research by the Healthcare Intelligence Network. This white paper summarizes awareness of and readiness for ACOs at 228 healthcare organizations, based on their responses to a February 2011 ACO Readiness Assessment. This research was conducted before CMS released its proposed rule governing ACOs.

To download this complimentary white paper, please visit:

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Less Preventive Care, Cost Savings Evident in High-Deductible Health Plans

While high-deductible health plans significantly cut health spending, such plans also prompt patients to cut back on preventive healthcare, according to a new RAND Corporation study that looked at more than 800,000 families from across the United States. Researchers examined the experiences of families insured during 2004 and 2005 through one of 53 large employers, with about half of the employers offering a high-deductible or consumer-directed health plan. Previous studies have tracked the impact of high deductibles, but the evidence has been limited to the experience of a few plans and employers.

Researchers found that when people shifted into health insurance plans with deductibles of at least $1,000 per person, their health spending dropped at an average of 14 percent when compared to families in health plans with lower deductibles. Healthcare spending was also lower among families enrolled in high-deductible plans that had moderate health savings accounts sponsored by employers. But when employer contributions to such savings accounts accounted for more than half of an individual's deductible, savings decreased among families enrolled in these so-called consumer-directed health plans. However, over the same period, families that shifted to high-deductible plans significantly cut back on preventive healthcare such as childhood immunizations, cancer screenings and routine tests for diabetes.

While childhood vaccination rates increased among families in traditional health plans, they fell among families in high-deductible health plans, according to the study. Rates of mammography, cervical cancer screening, colorectal cancer screening and routine blood tests among those with diabetes also fell among those with high-deductible health plans relative to those in other plans. The drop in preventive care occured even though the high-deductible plans in the study waived the need to pay a deductible when receiving such care. This suggests that enrollees in high-deductible plans either did not understand this part of their policy or some other factor discouraged them from getting preventive care, said the researchers. The findings about preventive care have implications for adoption of national healthcare reform in the United States. Under the federal Patient Protection and Affordable Care Act, health plan deductibles must be waived for preventive treatments. Researchers said the new study suggests that this fact must be clearly communicated to the public to meet the goal of increasing the level of preventive care received by Americans.

The RAND study also found that overall, healthcare costs grew for people enrolled in both high-deductible and traditional plans. However, they grew more slowly in the high-deductible group. Among those with high-deductible health plans, spending was lower on both inpatient and outpatient medical services, as well as prescription drugs. Spending for emergency care did not differ. Researchers also found that individual deductibles must be high to achieve meaningful cost savings. Cost growth for families covered in plans with moderate deductibles — from $500 to $999 per person — did not differ significantly from those in traditional plans. Cost savings only became significant when deductibles exceeded $1,000 per person.

High-deductible and consumer-directed health plans have been gaining favor as one way to help control healthcare costs. By 2009, about 20 percent of Americans with employer-sponsored health coverage were enrolled in such plans. A 2010 survey found that more than 54 percent of large employers offered at least one high-deductible health plan to their employees. Healthcare reform is expected to further encourage enrollment in high-deductible health plans as such plans are expected to be a key offering in the insurance exchanges being set up in many states to help the uninsured find health coverage.

To learn more about this research, please visit:

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Health & Wellness Incentives Use in 2011

Today is the last day to describe how your healthcare organization is using incentives to drive engagement and participation in health and wellness programs. Join the more than 125 healthcare companies that have shared their experiences with incentives by completing HIN's third annual survey on this topic today. 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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