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November 11, 2010 Volume VII, No. 19

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

A RAND Corporation study has found that even though older Americans are less healthy than the English, both populations expire at the same rate. Find out the reasoning behind this trend in this week's issue, as well as how a company improved medication adherence among their employees. And can exercise reduce endometrial cancer risk? Find the answer in this week's issue.

And don't forget to take our monthly esurvey on tobacco cessation and prevention programs.

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

This week's DM news:

Table of Contents

  1. Americans Less Healthy Than English
  2. Improving Medication Use Among Chronically Ill
  3. 2011 Patient-Centered Care
  4. Locating Populations for HRA Use
  5. Case Manager Communication Tools
  6. Benchmarks in Medication Adherence
  7. Endometrial Cancer & Exercise
  8. Tobacco Cessation and Prevention Programs

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Why Older Americans Less Healthy Than English Counterparts Live as Long or Longer

Older Americans are less healthy than their English counterparts, but they live as long or even longer than their English peers, according to a new study by the RAND Corporation and the Institute for Fiscal Studies in London. Researchers found that while Americans aged 55 to 64 have higher rates of chronic diseases than their peers in England, they died at about the same rate. And Americans age 65 and older — while still sicker than their English peers — had a lower death rate than a similar population in England. The study expands upon an earlier analysis that found that Americans aged 55 to 64 suffered from diseases such as diabetes at rates up to twice those seen among similarly aged people in England. The trend was observed across all socioeconomic groups.

Researchers say there are two possible explanations why death rates are higher for English after age 65 as compared to Americans. One is that the illnesses studied result in higher mortality in England than in the United States. The second is that the English are diagnosed at a later stage in the disease process than Americans. “Both of these explanations imply that there is higher-quality medical care in the United States than in England, at least in the sense that these chronic illnesses are less likely to cause death among people living in the United States,” said the researchers.

Researchers analyzed information from two comparable surveys of people age 50 and over in the United States and England — the Health and Retirement Survey and the English Longitudinal Survey of Aging — funded by the National Institute on Aging in the United States. In the study, researchers examined the prevalence of illness among those 55 to 64 and 70 to 80. They also looked for the first time at the onset of new illnesses in those age groups in the United States and England during the years spanning 2002 to 2006. Finally, researchers examined trends in death rates in each country.

The findings showed that both disease prevalence and the onset of new disease were higher among Americans for the illnesses studied — diabetes, high-blood pressure, heart disease, heart attack, stroke, chronic lung diseases and cancer. Researchers found that the higher prevalence of illness among Americans compared to the English that they previously found for those aged 55 to 64 was also apparent for those in their 70s. Diabetes rates were almost twice as high in the United States as in England (17.2 percent versus 10.4 percent) and cancer prevalence was more than twice as high in the United States (17.9 percent compared to 7.8 percent) for people in their 70s. In spite of both higher prevalence and incidence of disease in America, death rates among Americans were about the same in the younger ages in this period of life and actually lower at older ages compared to the English.

The study also investigated the relationship between the financial resources of individuals in both countries and how soon they would die in the future. While poorer people are more likely to die sooner than their more well-off counterparts, researchers say their finding supports the view that the primary pathway between health and wealth is that poor health leads to a depletion of household wealth, rather than being poor causes one's health to decline. Researchers found that the substantial changes in wealth that occurred in the years 1992 and 2002 in the United States through increases in stock prices and housing prices did not alter the probability of subsequent death.

To learn more about this research, please visit:

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More Affordable High-Value Prescriptions Improves Medication Adherence in Chronically Ill

An initiative by the U. S. technology company Pitney Bowes to make medications of proven value less expensive for their employees succeeded in stabilizing employees' adherence to their treatment regimens, according to a Commonwealth Fund-supported study published in this month's "Health Affairs."

The study found that adherence to cholesterol-lowering statin drugs, which had been on the decline, immediately stabilized after Pitney Bowes eliminated copayments for the drugs for all employees and beneficiaries who had diabetes or vascular disease. Adherence to statins was 2.8 percent higher in the Pitney Bowes group than in a control group of patients. Pitney Bowes also lowered copayments for all employees and beneficiaries prescribed the blood clot-inhibiting drug clopidogrel; the policy was also associated with an immediate stabilizing of the adherence rate. After a year, the Pitney Bowes group had a 4 percent higher adherence rate than the control group.

According to the authors, the findings are significant because this is one of the first studies to find success in value-based insurance design, which is intended to promote the use of services or treatments that provide high benefits relative to cost and, alternatively, to discourage the use of services whose benefits do not justify their cost. The study results suggest that employers and health plans that are raising deductibles and other types of cost-sharing for all services might be missing opportunities to improve their enrollees' health and achieve savings.

To learn more about this research, please visit:

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Patient-Centered Care Challenges for 2011

While the healthcare winds blew more favorably this year than they did in 2009, healthcare organizations will need key expertise to succeed in the year ahead, advises William Shea, a partner in health industry consulting for Cognizant Business Consulting. With the remix of healthcare delivery models brought on by healthcare reform, Shea identifies two challenges inherent in the trend toward patient-centered care that spans the entire continuum of care.

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Locating Populations for HRA Use

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Marcia Wade, MD, senior medical director at Aetna Medicare.

Question: How do you identify high risk populations?

Response: It’s almost easier to find risk in the elderly than it is in other populations because of the exponential rise that happens in medical costs. Those over 80 are eight or more times the cost of the younger population. It’s not only age and certain diseases like congestive heart failure (CHF) or diabetes where there’s a high disproportion of cost, but it’s also situational factors, such as people who have dementia who may be impoverished, or those on Medicaid, in the end of life or living in an institution.

The up side is that 73 percent or more of the cost that Medicare spends on medical care is for people who have not only one but five or more conditions at once. If you’re looking for high-risk people, the elderly that have five conditions or more is a high-yield place to start. After doing that data mining, you get to a population that has 30 times as much hospital use as those who have a much smaller number of medical conditions on a chronic basis.

For more benchmarks on HRA use, please visit:

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Key Case Manager Communication Tools

Healthcare case managers coordinate all phases of patient care — from management of the chronically ill to overseeing hospitalized patients from pre-admission through post-discharge. We wanted to identify the key communication tools that case managers use to communicate with their clients and patients.

Click here to view the chart.

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2010 Benchmarks in Medication Adherence Programs

Beyond increasing risk of death, poor medication adherence is tied to as much as $290 billion annually in increased medical costs and responsible for 33 to 69 percent of all medication-related hospital admissions in the United States, at a cost of about $100 billion per year. This white paper from the Healthcare Intelligence Network captures the efforts of 107 healthcare companies to improve medication adherence in their populations, from targeted populations and conditions of medication adherence programs to the components of a successful medication adherence program, as reflected by their responses to the January 2010 Medication Adherence e-survey.

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Exercise May Reduce Risk of Endometrial Cancer

Women who exercise for 150 minutes a week or more may see a reduced risk of endometrial cancer, whether or not they are overweight, according to data presented at the ninth annual AACR Frontiers in Cancer Prevention Research Conference. “This study is consistent with other studies that strongly support the association between physical activity and lower risk of endometrial cancer,” said Hannah Arem, a doctoral student at Yale School of Public Health.

Arem and colleagues examined data collected from a case-control study led by Herbert Yu, MD, MSc, PhD, associate professor at Yale School of Public Health. The study included 668 women with endometrial cancer and compared them to 665 age-matched control women.

Those who exercised for 150 minutes a week or more had a 34 percent reduced risk of endometrial cancer compared with those women who were inactive. This association was more pronounced among active women with a BMI less than 25, or underweight women, where the reduction in risk was 73 percent compared with inactive women with a BMI more than 25, or what is commonly considered overweight. Although BMI was strongly associated with endometrial cancer, even women who were overweight but still active had a 52 percent lower risk. According to Arem, “Programs should be in place to increase the level of physical activity in women.”

To learn more about this research, please visit:

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Tobacco Cessation and Prevention Programs

Cigarette smoking continues to be the leading cause of preventable morbidity and mortality in the United States, reports the U.S. Department of Health and Human Services. CDC data indicates that cigarette-smoking related healthcare expenditures in 2008 in the United States totaled nearly $96 million, and that the employer bears a cost of $3,391 per smoking employee per year, including $1,760 in lost productivity and $1,623 in excess medical expenditures. What is your organization doing in the areas of tobacco cessation and prevention? Complete HIN's Survey of the Month on tobacco cessation and prevention by November 30 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

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

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