Disease Management Update
Volume III, No. 32
November 30, 2006
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Table of Contents
- Insurance Bias in Breast Cancer Screening Recommendations
- Disease Management Q&A: Developing Care Plans for the Medicaid Population
- New! HealthSounds Podcast: Medicaid DM Program Design, Features and Results
- Medicaid Patients Less Likely to Receive Recommended Cardiac Care
- Health Literacy: Learning the Language of Healthcare in America
1. Insurance Bias in Breast Cancer Screening Recommendations
Compared to women with private health insurance, women with public health insurance such as Medicaid and Medicare are up to 30 percent less likely to receive a clinical breast exam, according to data from the National Ambulatory Medical Care Survey (NAMCS), a database run by the Centers for Disease Control and Prevention. Doctors are also up to 55 percent less likely to recommend that these women schedule a mammogram.
"Almost every medical association in the country recommends that a woman 45 and older get screened annually or at least every two years," said Rajesh Balkrishnan, the Ohio State University professor of pharmacy who led the study analyzing the data. "Medicare and Medicaid pay for at least a portion of the cost of both exams for covered individuals. But patients and physicians may not be aware of this."
"A physician's recommendation is why many women undergo screening in the first place," Balkrishnan said. "Foregoing these exams can increase a woman's risk of developing an advanced stage of breast cancer."
Elderly women and women who don't go to an obstetrician and gynecologist for routine exams are also less likely than others to get a clinical breast exam and a recommendation for a mammogram.
To learn more about the findings of this study, please visit:
2. Disease Management Q&A: Developing Care Plans for the Medicaid Population
Each week, a healthcare professional responds to a reader's
query on an industry issue. This week's expert is Jerry Kiplinger, executive director of APS Healthcare.
Question: How do you develop appropriate care plans and what is the role of the primary care provider (PCP) in this process?
Response: In addition to keeping regular correspondence with the PCP, we're trying to streamline our health risk assessment (HRA) analysis. Clinical assessments vary in time, depending on the clientele, so we need to refine the procedure and make it appropriate to the most current disease state presented by the patient. Building rapport is the underlying goal within every interaction.
We try to get the current treatment plan from the PCP as early as possible. If a patient has diabetes, is newly diagnosed or is referred into our system by a provider, we want that provider to give us his or her treatment plan so we can incorporate it into our clinical case management system and use it accordingly. Also, this reassures physicians that we assess the same clinical indicators as they do and we're not going to stray from the treatment plan.
For more details on care coordination, maximizing resources, determining program eligibility and engaging Medicaid patients, please visit:
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3. New! HealthSounds Podcast: Medicaid DM Program Design, Features and Results
In this week's Disease Management podcast, David Hunsaker, president of public programs with APS Healthcare, dispels some of the myths about the Medicaid population and describes how to maintain contact and reduce non-urgent emergency room usage among Medicaid recipients. In addition, Elizabeth Reardon, managed care director with Vermont Health Access, discusses the challenges of serving a rural population in Medicaid disease management programs as well as how case managers can utilize home visits — conducted either by the case manager or by other service providers already visiting the home — to help coordinate the care of Medicaid patients.
To listen to this complimentary HIN podcast, please visit:
4. Medicaid Patients Less Likely to Receive Recommended Cardiac Care
The quality of cardiac care for Medicaid patients lags behind the care given to those with health management organization (HMO) plans and private insurance, according to a study published in the Annals of Internal Medicine. The study found Medicaid patients were less likely to receive short-term medications and to undergo invasive cardiac procedures. They also had higher in-hospital mortality rates and were less likely to receive recommended discharge care. Differences were fewer and smaller for Medicare patients.
Medicaid patients were less likely to receive aspirin, beta-blockers, clopidogrel and lipid-lowering agents. They were also less likely to receive dietary counseling, smoking cessation counseling and referral for cardiac rehabilitation. In addition, delays were observed for Medicaid patients in the time to first electrocardiogram and in time to cardiac catheterization and revascularization when these procedures were performed.
Medicaid patients had higher in-hospital mortality rates (2.9 percent vs. 1.2 percent) and after adjustment, the risk for death was approximately 30 percent higher in Medicaid patients compared to those with HMOs and private insurance.
To see more of this study's results, please visit:
5. Health Literacy: Learning the Language of Healthcare in America
The universal application of healthcare makes it ever more important for system users to learn its language. To make patients more conversant in this language, recent healthcare reform is striving to empower them through education and access to information while enhancing physicians' abilities to convey the message. Health literacy programs are on the forefront of this development — helping patients learn how to better help themselves.
In a recent online survey conducted by the Healthcare Intelligence Network (HIN), healthcare organizations and outsourcing firms discussed programs they have developed to improve health literacy. Outlining initiatives from audiences to outcomes, participants describe their strategies for promoting health literacy in this free executive summary.
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