1.
Wal-Mart Says
$4 Drug Plan Saves $1B
Wal-Mart Stores Inc., the world's largest retailer, on Friday estimated its $4
generic prescription drug program saved customers more than $1 billion since it
launched. Wal-Mart began offering $4 for a one-month supply of many generic
prescriptions in late 2006. The company said the $4 prescriptions now represent
about 40 percent of all filled prescriptions at Wal-Mart. Nearly 30 percent are
filled without insurance.
Forbes, March 14, 2008
http://www.forbes.com/feeds/ap/2008/03/14/ap4773666.html
2.
Insurers, doctors at odds over `concierge' care
Doctors who charge an annual fee to patients in exchange for customized care
including house calls are drawing the ire of some health insurance companies.
United Healthcare confirmed it is dropping four local doctors from its network
in April because the company disapproves of their so-called "concierge medicine"
model. Cigna is also condemning the practice, in which physicians charge an
annual retainer of $1,500 to $1,800 for patients who then receive more personal
care. Cigna would not say whether it is dropping any Houston-area physicians,
but spokeswoman Gwyn Dilday said, "Charging membership fees to guarantee access
is a violation of our contract terms and may result in termination." Concierge
medicine is a relatively small movement in the U.S.
Houston Chronicle, March 13, 2008
http://www.chron.com/disp/story.mpl/headline/biz/5618372.html
3. Drawing Lots for
Health Care
Last month, right after he had the heart attack and then the heart surgery and
then started receiving the medical bills that so far have topped $200,000,
Melvin Tsosies joined the 91,000 other residents of Oregon who had signed up for
a lottery that provides health insurance to people who lack it. “They said
they’re going to draw names, and if I’m on that list, then I’ll get health
care,” said Mr. Tsosies, 58, a handyman here in booming Deschutes County. “So
I’m just waiting right now.” Despite the great hopes of people like Mr.
Tsosies,
only a few thousand of Oregon’s 600,000 uninsured residents are likely to
benefit from the lottery anytime soon. The program has only enough money to pay
for about 24,000 people, and at least 17,000 slots are already filled.
New York Times, March 13, 2008
http://www.nytimes.com/2008/03/13/us/13bend.html
4. HHS official
urges participation in electronic health records project
U.S. Health and Human Services Secretary Michael Leavitt invited health care and
community leaders yesterday to participate in a new effort to expand electronic
health record systems in physician offices. During a visit to Pittsburgh, Mr.
Leavitt urged local leaders to support a Medicare demonstration project that
will give incentive payments to doctors who install the systems and meet certain
guidelines for improving care. Implementing electronic systems that meet uniform
standards would help transform the nation's health care sector into a health
care system, Mr. Leavitt told about 40 representatives of physician, hospital
and business groups, consumer advocates and others at the Regional Enterprise
Tower, Downtown.
Pittsburgh Tribune-Review, March 13, 2008
http://www.post-gazette.com/pg/08073/864762-114.stm
5.
Universal can resume writing new policies in S.C.
A Florida-based health insurer that was ordered to stop writing new policies in
the Palmetto State last year has been given a clean bill of health and can
resume its operations. In August, Universal Health Care Insurance Co. of St.
Petersburg, Fla., was suspended from writing any new business in South Carolina
by the Department of Insurance amid concerns that the company's rapid growth had
outstripped its ability to pay claims. The department placed an "order of
supervision" on Universal after its business in South Carolina increased by more
than 10 times what the company had predicted. The move followed similar measures
by officials in Florida, Georgia, Nevada and Utah.
The Post & Courier, March 12, 2008
http://www.charleston.net/news/2008/mar/12/universal_can_resume_writing_new_policie33534/
6.
Aetna to offer wealth of health data online
Aetna Inc. is offering its members a new online search tool that connects to
easy-to-understand articles, local doctors who specialize in their needs, as
well as cost information based on their personal health record and benefits. The
service is a result of a partnership with Healthline Networks, a San Francisco
health-technology company that develops software to navigate health searches.
"Consumers are now shifting from a 'doctor is God' mentality to one of 'my
doctor is a potential ally ... but I need to take control,' " said Dean
Stephens, Healthline's president and chief operating officer. "The evidence says
a more informed consumer is a healthier consumer. A healthier consumer costs
less."
San Francisco Chronicle, March 12, 2008
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/03/11/BUAUVH7EG.DTL&type=tech
7.
U.S. prescription drug sales growth slowest since 1961 -- IMS Health
IMS Health said overall 2007 U.S. prescription drug sales growth was 3.8% to
$286.5 billion, the slowest growth rate since 1961, compared with an increase of
8% in 2006, as the shift away from primary care classes to biotech and
specialist-driven therapies continued. According to IMS' U.S. Pharmaceutical
Market Performance Review, total U.S. dispensed prescription volume growth
declined to 2.8% in 2007 from 4.6% in 2006. The leading therapy class dispensed
was antidepressants. Rounding out the top five were lipid regulators, codeine
and combination pain medications, ace inhibitors and beta blockers.
CNNMoney.com, March 12, 2008
http://money.cnn.com/news/newsfeeds/articles/newstex/AFX-0013-23705987.htm
8.
Humana Error May Be Anomaly, Managed-Care Group Hit Again
Health insurer Humana Inc. attributed its dramatic 2008 profit warning Wednesday
to miscalculations in designing its current Medicare prescription drug plans and
sought to assure investors the problem was limited to this year and that
program. In spite of the effort to allay concerns, and what looked to be a
company- specific error, Humana's disclosure extended the battering that Wall
Street delivered to managed-care stocks Tuesday in response to a drastic
earnings warning from WellPoint Inc. . The stocks of two major players moved up
a bit in early trading, however.
CNNMoney.com, March 12, 2008
http://money.cnn.com/news/newsfeeds/articles/djf500/200803121212DOWJONESDJONLINE000790
_FORTUNE5.htm
9.
Health views differ along ethnic lines
Minorities are more likely than white patients to rate their health care as fair
or poor, a view that is particularly true among Chinese-Americans, blacks born
in Africa and Vietnamese-Americans. Researchers have long stressed that
improving patients' perception of their care is important to improving outcomes.
That's because negative experiences can lead to less time spent with a physician
and poor communications between doctor and patient.
Yahoo!/Associated Press, March 11, 2008
http://news.yahoo.com/s/ap/20080311/ap_on_go_ot/health_disparities_study_2
10.
WellPoint Plummets, Pulling Down Health Insurers
WellPoint Inc., the second-largest U.S. health insurer, plunged the most ever in
New York trading after cutting its forecast on costlier medical claims and a bad
flu season, sending the industry to its worst day in a decade. UnitedHealth
Group Inc., Aetna Inc., and Humana Inc. all plummeted as analysts issued a
flurry of downgrades for individual companies. Six analysts downgraded WellPoint,
while Bear Stearns and Goldman Sachs cut price targets for numerous companies
and lowered the industry's overall rating. WellPoint has lost about $13 billion
in market value in the last week.
Bloomberg, March 11, 2008
http://www.bloomberg.com/apps/news?pid=20601087&sid=asptnLd5zHWs&refer=home
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AHRQ's Annual Healthcare Quality and Disparities Reports
AHRQ this month issued their companion 2007 National Healthcare Quality and National Healthcare Disparities Reports. Their reports compile more than 50,000 data points from three dozen mostly federal health agency databases. What did they seek to find out, and what did they conclude?
The Quality Report asks "Have Federal and State governmental agencies, provider organizations, insurers, and employers
made progress in improving health care quality and safety?" The Disparities Report queries "Are we getting better at addressing disparities in the quality of and access to health care for priority populations in America?"
In answer to these questions the reports conclude stakeholders must "emphasize the need to accelerate progress in achieving high quality health care [because: 1] Health care quality continues to improve, but the rate of improvement has slowed; [2] Variation in quality of health care across the Nation is decreasing, but not for all measures; [and 3] The safety of health care has improved since 2000, but more needs to be done." With regard to disparities, they also find "three key themes emerge: [1] Overall, disparities in health care quality and access are not getting smaller; [2] Progress is being made, but many of the biggest gaps in quality and access have not been reduced; [and 3] The problem of persistent uninsurance is a major barrier to reducing disparities.
The reports cites that Core Quality Measures improved 2.3% annually 1994- 2004, but that shrinks to 1.5% from 2000- 2005. Perhaps AHRQ should not be so hard on themselves or others. It would seem inevitable that rates of improvement would decline over time as the "lowest hanging fruit" for improvement is picked from the tree.
Still, it hard to argue that more can and should be done. It's interesting to compare improvement in core quality measures from 2000 to 2005 by key settings:
- Hospitals 2.9%
- Home Health 2.8%
- Ambulatory Care 1.7%
- Long Term Care 0.8%
Similarly, consider the improvement rates by key conditions, for the same time period:
- Heart Disease 5.6%
- Cancer 3.6%
- Maternal and Child Health 1.5%
- Safety 1.0%
- Diabetes 0.6%
Given the national trends in obesity, and aging demographics, underperformance in long term care and diabetes certainly is a cause for concern.
Regarding long term care, the report cites variation as a problem. "In 2002, chronic care nursing home residents were restrained 8.3 times more frequently in the worst performing State than in the best performing State. In 2006, this ratio increased to 10. If all States had reached the average of the best performing State in 2006, at least 61,500 fewer residents would have been physically restrained nationwide.
And with diabetes, the report again points out variation. "In 2000, diabetic patients were admitted to the hospital with uncontrolled diabetes 7.6 times more often in the worst performing State than in the best performing State. By 2004, this difference had nearly doubled, with uncontrolled diabetes admissions per 100,000 population in the worst performing State 14
times higher than in the best performing State. If all States had reached the level of the four best performing States in 2004, almost 39,000 fewer patients would have been admitted for uncontrolled diabetes, with a potential cost savings of $216.7 million."
But there are successes to point to. Consider the significant improvement in heart disease. The report cites that over 93% of heart attack patients received the recommended hospital care in 2005, compared to 77% in 2000. Another of the 16 heart disease measures is for heart attack patients to receive counseling to quit smoking. The report found that 91% were counseled in 2005 compared to 43% in 2000. Using this as an example of reduction in variation, the report notes that "in 2002, the rate at which heart attack patients in hospitals were counseled to stop smoking by their doctor in the best performing State was 3.3 times higher than the rate for their counterparts in the worst performing State. However, over just 3 years, most States improved their performance on this measure....all States in 2005 had reached the level of the best performing States in 2002. In 2005, only two States were below 80% on this measure." Examining the reports data maps, one can see that in 2002 ten states fell in the 20.8% to 44.% range for counseling, and 14 states fell in the 45.9% to 50.5% range. In 2005, every state was above 57%.
The National Healthcare Disparities Report (NHDR) "describes the quality of and access to care for multiple subgroups across the United States, and also represents a source of information for tracking the Nation’s progress over time. The observed disparities vary by condition and population." The report finds that "overall, disparities in quality and access for minority groups and poor populations have not been reduced since the first
NHDR. Based on 2000 and 2001 data compared with this year’s 2004 and 2005 data (depending on the data source), the number of measures on which disparities have gotten significantly worse or have remained unchanged since the first NHDR is higher than the number of measures on which they have gotten significantly better for Blacks, Hispanics, American Indians and Alaska Natives, Asians, and poor populations."
The report cites the following successes regarding disparities: "The disparity between Black and White hemodialysis patients with adequate dialysis was eliminated in 2005. The disparity between Asians and Whites who had a usual primary care provider was eliminated in 2004. The disparity between Hispanics and non-Hispanic Whites and between people living in poor
communities and people living in high income communities for hospital admissions for perforated appendix was eliminated in 2004. Significant improvements were observed in childhood vaccinations for most priority
populations."
The report also points out key areas with no improvement: Blacks had a rate of new AIDS cases 10 times higher than Whites; Asian adults age 65 and over were 50% more likely than Whites to lack immunization against pneumonia; American Indians and Alaska Natives were twice as likely to lack prenatal care in the first trimester as Whites; Hispanics had a rate of new AIDS cases over 3.5 times higher than that of non-Hispanic Whites; Poor children were over 28% more likely than high income children to experience poor communication with their health care providers.
Disparities seems significantly more noticeable regarding the poor. The report provides a chart of disparity measures for
population groups in regard to their change in core measures from 2000 to 2005:
Core Measures 2000 vs 2005
|
Improving |
Same |
Worsening |
| Black vs White |
6 |
9 |
1 |
| Asian vs White |
5 |
8 |
3 |
| Hispanic vs Non Hispanic White |
7 |
6 |
3 |
| Poor vs High Income |
6 |
4 |
7 |
The report notes the three largest disparity gaps for poor were: (1) Children whose parents reported poor communication with their health providers; (2) Adults who can sometimes or never get care for illness or injury as soon as wanted; (3) Women age 40 and over who reported they did not have a mammogram within the past two years
The report did state that the disparity measure of persons under age 65 with health insurance reduced from 2000 and 2005, but we might venture that this was partially due to the fact the uninsured rate has increased for the non-poor as well. Certainly, the greater lack of health coverage for the poor is the driver for their greater overall disparities. The report cites that "uninsured individuals do worse than privately insured individuals on almost 90% of quality
measures. Uninsured individuals do worse than privately insured individuals on all access measures."
For More Information:
Modest Health Care Quality Gains Outpaced by Spending
AHRQ Press Release, March 3, 2008
http://www.ahrq.gov/news/press/pr2008/qrdr07pr.htm
2007 National Healthcare Quality & Disparities Reports
AHRQ, March 2008
http://www.ahrq.gov/qual/qrdr07.htm
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