Posts Tagged “Care Management”
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Rand Research on the Benefits of Integrated Care.
by Kevin Roche on Tuesday, May 14, 2013
A new paper from Rand looks at the effect of integrated care on a variety of outcomes, including provider and patient satisfaction, quality and costs.
Tags: Care Management, Health Care Costs, Health Care Quality, Physicians
Diabetes Care Improvement
by Kevin Roche on Friday, April 26, 2013
Even after all the emphasis on guidelines and pay-for-performance the quality of care for diabetes patients has shown only very moderate improvement in the last ten years.
An Alternative Method for Engaging Patients
by Kevin Roche on Monday, March 18, 2013
An article in Health Affairs discusses an alternative to patient engagement on health care decisions–using the findings of behavioral economics and pyschology to encourage patients to adopt a desired path or care alternative.
Use of Online Clinic Visits
by Kevin Roche on Thursday, March 7, 2013
New methods for delivering care in a more convenient method continue to evolve, including use of online visits. A study in Health Affairs reports on results of one health plan’s use of an online model for treating some conditions.
Tags: Care Management, Health Care Costs, HIT
Concierge Care Effects
by Kevin Roche on Friday, February 8, 2013
A study in the American Journal of Managed Care looks at the effect on hospital utilization for patients who were care for in one of the country’s leading concierge practices.
Tags: Care Management, Concierge Medicine, Health Care Costs, Hospital, Physicians
2012 Potpourri XL
by Kevin Roche on Friday, December 28, 2012
Our last Potpourri for 2012 is the ultimate in health information, containing not lumps of coal but tasty nuggets of holiday goodies, including transition care from hospital to primary care, how to control health spending growth, use of market incentives to improve the health system, building a good health insurance exchange and Massachusetts’ experience with the uninsured after reform.
Tags: Care Management, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, Health Insurance Exchange, Hospital Readmissions, Transitional Care
Review of Medical Home Evidence
by Kevin Roche on Thursday, December 27, 2012
Patient-centered medical homes, accountable care organizations, who can keep all the delivery innovations straight! Research summarized in an Annals of Internal Medicine article reviews the state of the evidence on the use of medical homes. So far, not great, small gains in quality and no showing of overall cost savings.
Tags: Care Management, Health Care Costs, Health Care Quality, Medical Homes, Physicians
Medication Adherence Interventions
by Kevin Roche on Tuesday, December 11, 2012
Medication adherence is a serious quality of care issue, although its cost implications are often exaggerated. Research continues apace to understand why people don’t take their drugs and what interventions may work to improve adherence. An Annals of Internal Medicine article summarizes the state of the art.
Tags: Care Management, Drugs, Health Care Quality
The Cost of Medication Non-Adherence
by Kevin Roche on Thursday, December 6, 2012
Medication non-adherence has many causes and is likely a serious quality issue. Capgemini, the consulting group, has released a report claiming that such non-adherence adds hundreds of billions of dollars to our health care spending, and costs drug companies a similarly large amount of revenue.
Tags: Care Management, Consumers, Drugs, Health Care Costs, Health Care Quality
Personalized Medicine Rolls Along
by Kevin Roche on Monday, November 19, 2012
An article in Nature describes a study of over 1000 individual genomes to identify variation. This is an important step in the continuing evolution of personalized medicine, which is proving to take longer and be more complex that may have initially been imagined.
More on End-of-Life Care
by Kevin Roche on Wednesday, November 14, 2012
A substantial amount of Medicare and overall health spending is incurred in the last few months of patients’ lives. Much of this spending is due to intensive care that obviously is rather superfluous at that point. A new article in the Journal of Clinical Oncology reports on research regarding end-of-life discussions and resulting care.
Tags: Care Management, End-of-Life Care, Health Care Costs, Health Care Quality
2012 Potpourri XXXIII
by Kevin Roche on Friday, November 2, 2012
Another installment of our non-award winning (are there any potential awards?) Potpourri, this one examining drug costs for conditions of aging, self-referral in imaging, in home palliative care at the end-of-life, more on hospital readmissions and retail clinic utilization.
Tags: Care Management, Drugs, End-of-Life Care, Health Care Costs, Hospital Readmissions, Physicians, Retail Clinics
2012 Potpourri XXXII
by Kevin Roche on Friday, October 26, 2012
The light fades but not our evanescent Potpourri, this week featuring stories on computerized point of entry ordering, the presence of large treatment effects in research, characteristics of patients with readmissions, a survey on Medicare physician reimbursement and a study on family caregivers.
Tags: Care Management, Health Care Costs, Health Care Quality, Health Care Research, HIT, Hospital Readmissions, Medicare, Physicians
2012 Potpourri XXXI
by Kevin Roche on Friday, October 19, 2012
It is cooling down across most of the country, but our Potpourri remains red-hot, with nuggets on the moderation in health spending over the last few years, how to change automatic health behaviors, EHRs and diabetes care, a medical home pilot in Colorado and an ACO demonstration in Maine.
Tags: ACO, Care Management, EHRs, Health Care Costs, Health Care Quality, medical home, Wellness and Prevention
Medication Adherence Interventions
by Kevin Roche on Monday, October 8, 2012
Medication adherence is a widespread problem in health care, ranging from failure to even pick up a prescription to failure to follow instructions on when and how to use the drug. A number of interventions have been tried to improve adherence and an Agency for Healthcare Research and Quality review seeks to ascertain what evidence there is for effectiveness for these interventions.
Tags: Care Management, Drugs, Health Care Quality
2012 Potpourri XXIX
by Kevin Roche on Friday, October 5, 2012
Our first Potpourri in a while is as diverse and flamboyant as the fall colors, including items on the effectiveness of telemonitoring, the history of health “reform” in the United States, mortality and Medicaid eligibility expansions, continued issues with cost affecting access in Massachusetts and methods to help control imaging use.
Tags: Care Management, Health Care Costs, Health Care Quality, Health Care Reform, Medicaid, Medicare, Telemedicine
CMS’ Physician Group Practice Demo Results
by Kevin Roche on Wednesday, October 3, 2012
The Physician Group Practice Demonstration conducted by Medicare has largely wrapped up , to be supplanted by the accountable care organization programs. The PGP demo appears to have led to slightly improved quality and has led to slightly lower cost savings over traditional fee-for-service Medicare.
Tags: Care Management, Disease Management, Health Care Costs, Health Care Quality, Medicare, Physicians
2012 Potpourri XXVI
by Kevin Roche on Friday, August 17, 2012
Another sunny Potpourri, brightening your day with rays of data on hospital at home; Medicare care coordination programs; an employer survey on impacts of the reform law; a survey on health habits and employee productivity; first quarter health plan results and ER use and end-of-life care.
Tags: Care Management, End-of-Life Care, Health Care Costs, Health Care Reform, Health Insurance, Hospital, Medicare, Wellness and Prevention, Workplace
2012 Potpourri XXIV
by Kevin Roche on Friday, August 3, 2012
The length of the summer day begins to decline, but not the quality of our Potpourri, this week including patient decision-making, the effect of genetic tests on overall health care use, an employee survey on health benefits, the growing market power of hospital systems, making decision aids more user friendly and physician compensation.
Tags: Care Management, Health Care Costs, HIT, Hospital, Physicians
AHRQ on Improving Health Care Decision-Making
by Kevin Roche on Wednesday, June 27, 2012
The Agency for Healthcare Research and Quality has issued a report looking at use of clinical decision support and knowledge management systems, finding some evidence for positive health and cost outcomes, but also large gaps in our understanding of how to maximize the value of these technologies.
Tags: Care Management, Health Care Quality, HIT
2012 Potpourri XX
by Kevin Roche on Friday, June 15, 2012
Our Potpourri resumes, with information on consumer trust of insurers and providers, consumer use of online health information, price transparency in health care, imaging rates in integrated health care systems and effectiveness of telephonic depression therapy.
Tags: Care Management, Consumers, Health Care Costs, Health Care Quality, HIT, Physicians, Telemedicine
2012 Potpourri XIX
by Kevin Roche on Friday, June 1, 2012
Summer is heating up and our Potpourri is smoking too, with nuggets on a silly provision in the final MLR rule; research on causes of readmissions, some within hospital control, some not; why are some hospitals more costly in treating heart failure than others and an unintended consequence of a change in dialysis drug reimbursement.
Tags: Care Management, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, Hospital, Medicare, Physicians, Readmissions, Reimbursement
Care Management Kills?
by Kevin Roche on Wednesday, May 30, 2012
Research reported in the Annals of Internal Medicine finds that a comprehensive care management program for chronic obstructive pulmonary disease had excess mortality, to the point that the trial was stopped early. It seems unlikely that this was actually due to the trial.
2012 Potpourri XV
by Kevin Roche on Friday, April 27, 2012
Another tremendous edition of our Potpourri, featuring accountable care organization results, waste in our health system, self-referral costs, calculating hospital readmission rates and the benefits, if any, of telemonitoring frail seniors.
Tags: ACO, Care Management, Disease Management, Health Care Costs, Hospital Readmissions, Medicare, Physicians, Regulation, Telemedicine
Physicians on Inappropriate Medical Care
by Kevin Roche on Thursday, April 5, 2012
Physicians are as aware as anyone of the need to control health spending. Several physician specialty associations have released lists of procedures or treatments that consumers and doctors should question before using. This hopefully reflects a trend of physicians being more engaged in delivering only needed care.
Tags: Care Management, Consumers, Health Care Costs, Physicians
Knowledge and Health Behavior
by Kevin Roche on Wednesday, April 4, 2012
A new study from the National Bureau of Economics finds that greater levels of education are associated with better health behaviors, without regard to specific knowledge of health risks or to a person’s native level of intelligence. Better educational attainment may in turn reflect family circumstances.
Tags: Care Management, Consumers
2012 Potpourri XI
by Kevin Roche on Friday, March 30, 2012
Welcome to another Potpourri of health information, focusing on workers’ comp medical prices, cost-sharing on asthma meds, the Medicare Advantage program, doctors’ experience of quality improvement programs, a review of the last 60 years in health economics and the value of teledermatology.
Tags: Care Management, Consumers, Drugs, Health Care Costs, Health Care Quality, Medicare, Physicians, Telemedicine, Workplace
2012 Potpourri X
by Kevin Roche on Sunday, March 25, 2012
Spring is in the air but take a few minutes to refresh with our latest Potpourri, which includes the Congressional Budget Office’s latest health reform projections, ER use by those with Medicaid or private insurance coverage, the effect of selective outcomes reporting in research, an AonHewitt survey of employers on exchange use, another CBO report on employer incentives for use of TriCare and physician costs to comply with quality mandates.
Tags: Care Management, Comparative Effectiveness, Consumers, Employers, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance Exchanges, Medicaid, Physicians
Medical Home Research
by Kevin Roche on Thursday, March 22, 2012
A review article in the American Journal of Managed Care summarizes the evidence to date on medical homes. The results look modestly promising, with evidence of improving quality of care, some signs of cost control, but other evidence that suggests net cost increases.
Tags: Care Management, Health Care Costs, Health Care Quality, Medical Homes
AHRQ on Readmissions
by Kevin Roche on Tuesday, March 13, 2012
With the advent of the Center for Medicaid and Medicare Services hospital readmission penalty program, hospitals are scrambling to try to identify potential readmissions and manage them. A new Agency for Healthcare Research & Quality report gives some basic data on hospital readmissions for chronic and acute conditions.
Tags: Care Management, Hospital, Readmissions
Nursing Home Versus Home Care
by Kevin Roche on Thursday, March 8, 2012
One of the causes of rapid health spending growth is the aging of our population. A new report from the Agency for Healthcare Research & Quality reviews the literature on home and community-based care for the elderly versus institutional care in nursing homes.
Tags: Care Management, Elder Care, HomeCare
Well-Being and Health Care Use
by Kevin Roche on Tuesday, March 6, 2012
Wellness programs are popular among employers and payers because of a perception that they can reduce health care spending, at least in the long run. A new study published in the Population Health Management journal tests whether such programs can lead to an enhanced sense of overall well-being among particpants.
Patient Perceptions and Illness
by Kevin Roche on Monday, February 20, 2012
Placebo and nocebo effects are just part of the broader topic of how patient perceptions about their health, illnesses and treatments may affect outcomes. An article in Current Directions in Psychological Science summarizes research on patient perception of illness.
2012 Potpourri V
by Kevin Roche on Friday, February 3, 2012
Another Potpourri brimming with doses of useful information that you eagerly await each week, including Medicare special needs plans and patients with diabetes, health information technology venture capital funding and M & A, identifying overuse in health care, what makes a better medical group, does merging weak hospitals help them and interventions that appear to work to prevent development of diabetes.
Tags: Care Management, Chronic Disease, Financings, Health Care Costs, Hospital, M&A, Medicare, Physicians
2012 Potpourri IV
by Kevin Roche on Friday, January 27, 2012
Another zinger of a Potpourri, with nuggets on a GAO audit of NQF work, use of web tools for diabetes management, the Healthways well-being index, the problem with federal health spending, hospital job losses from reimbursement cuts, and reducing unnecessary testing.
Tags: Care Management, Health Care Costs, Health Care Quality, HIT, Hospital, Physicians, Wellness and Prevention
CBO on Medicare’s Care Management Demos
by Kevin Roche on Tuesday, January 24, 2012
The Centers for Medicare and Medicaid Services has engaged in a number of care management demonstrations over the years. The Congressional Budget Office adds its assessment to the body of research examining the outcomes of those demostrations.
Tags: Care Management, Chronic Disease, Disease Management, Health Care Costs, Health Care Quality, Medicare
2012 Potpourri II
by Kevin Roche on Friday, January 13, 2012
Our latest Potpourri reveals details about causes of workplace injuries, the effect of raising the Medicare eligibility age, benefit levels in existing health policies, false claims prosecutions and off-label drug use, ICU staff perceptions of the appropriateness of care, and malpractice liability from clinical decision support systems.
Tags: Care Management, Drugs, Health Insurance, HIT, Medicare, Workplace
Chronic Disease Management Savings
by Kevin Roche on Monday, January 9, 2012
A report from the Urban Institute projects what savings might be available from greater use of intensive care management for persons with serious, multiple chronic diseases.
Tags: Care Management, Chronic Disease, Disease Management, Health Care Costs
2012 Potpourri I
by Kevin Roche on Friday, January 6, 2012
Welcome to 2012, when you can once again expect a series of high-quality Potpourris from our immense data bank! Our initial foray includes the Independence at Home CMS demo, discharge summaries and hospital readmissions, CMS’ quality measures for Medicaid patients, private equity fundraising, medical homes and cost savings for Medicaid patients and the effect of poor discharge summaries on nursing home patients.
Tags: Care Management, Financings, Health Care Quality, HomeCare, Hospital, Medicaid, medical home, Medicare, Readmissions
Disease Registries
by Kevin Roche on Monday, December 12, 2011
Disease registries are used to track a number of patients with a common condition to determine factors which affect their outcomes and to help guide their treatment. An article in Health Affairs reviews a number of disease registries in several countries, finding that they have a high potential to improve overall quality.
Tags: Care Management, Chronic Disease, Health Care Costs, Health Care Quality
Obesity and Weight Management Interventions
by Kevin Roche on Wednesday, December 7, 2011
Obesity is often fingered as a leading cause of health care spending and health spending growth. It also causes significant personal discomfort to those who are overweight. A pair of articles in the NEJM describe the outcomes of interventions to help patients lose weight.
Tags: Care Management, Chronic Disease, Consumers, Providers, Wellness and Prevention
2011 Potpourri XXXXV
by Kevin Roche on Friday, November 18, 2011
No Potpourri next week due to the holiday, so enjoy this festive collection of health care nuggets, including pay-for-performance in large physician groups, employer views on the effect of the reform law, the effect of physician financial interest in cardiac testing, experience with high deductible plans, medical homes and quality improvement and for-profit and non-for-profit hospital treatment of the uninsured.
Tags: ACO, Care Management, Consumer Directed Health, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, Hospital, medical home, Pay For Performance, Physicians
2011 Potpourri XXXXIV
by Kevin Roche on Friday, November 11, 2011
The cold is approaching so curl up on the sofa and enjoy the warmth of our Potpourri, this week featuring results from a pay-for-performance program, the effect of the health insurance tax on premiums and employment, the evidence for a stroke treatment, collaborative care for heart disease and physicians views on their practices and health information tools.
Tags: Care Management, Consumers, Evidence-based care, Health Care Reform, Health Insurance, Medical Care, Pay For Performance, Physicians
Hospital Transition Care
by Kevin Roche on Thursday, November 10, 2011
It stands to reason that a care transition program will improve outcomes in regard to hospitalized stroke and heart attack patients, but an AHRQ research review finds little solid evidence that this is the case for most types of care transition interventions.
Tags: Care Management, Disease Management, HomeCare, Hospital
2011 Potpourri XXXXII
by Kevin Roche on Friday, October 28, 2011
Another brilliant Potpourri, with scintillating health care gems, including revising the FDA’s 510(k) process, the essential benefits package for health exchanges, the future of Medicare Advantage, the lack of labor productivity in health care, variation in elective procedure rates and the OIG’s work plan.
Tags: Care Management, Devices, FDA, Government, Health Care Costs, Health Care Reform, Health Insurance, Medical Care, Medicare, Physicians
Care Coordination for the Dual Eligible Population
by Kevin Roche on Wednesday, October 26, 2011
Medicare/Medicaid dual eligibles are relatively poor, elderly or disabled persons who have very high health spending. A report from America’s Health Insurance Plans discusses how care coordination programs can achieve significant savings for the programs and better health outcomes for the patients.
Tags: Care Management, Chronic Disease, Health Care Costs, Medicaid, Medicare
2011 Potpourri XXXXI
by Kevin Roche on Friday, October 21, 2011
Another Potpourri, with tidbits on the Medicare Star program results for 2012, pain management, blood pressure management, Massachusetts’ physicians’ views on work and health care, online error reporting and the FDA and CMS parallel medical device review process.
Tags: Care Management, Devices, FDA, Health Insurance, Malpractice, Medical Care, Medicare, Physicians, Telemedicine
Telehealth Care Management
by Kevin Roche on Thursday, October 13, 2011
The effect of telehealth tools on the health spending of Medicare beneficiaries with chronic disease has been controversial, with a number of studies finding no or very limited savings. New research published in Health Affairs suggests that at least one such tool may contribute to savings in a care management program for common chronic diseases.
Tags: Care Management, Disease Management, Health Care Costs, Medicare, Telehealth
2011 Potpourri XXXIX
by Kevin Roche on Friday, October 7, 2011
October already!! Our 39th Potpourri of the year has many autumnal pleasures including selections on CMS’ Comprehensive Primary Care Initiative, a proposed guidance for FDA to use for mHealth regulation, end-of-life care discussions, CMS’ multi-payer database award, expected 2012 medical trend, and delivery of unnecessary care by doctors.
Tags: Care Management, Comparative Effectiveness, End-of-Life Care, FDA, Health Insurance, HIT, medical home, Medicare, Physicians, Telemedicine
Medical Homes
by Kevin Roche on Wednesday, September 7, 2011
The medical home concept lumbers on, sometimes mixed in with the accountable care organization notion. The current status of the concept and issues affecting its ultimate impact are assessed in a new report from the Urban Institute and the Robert Wood Johnson Foundation.
Tags: Care Management, Consumers, Medical Care, Physicians
Shared Decision Making
by Kevin Roche on Thursday, August 25, 2011
A report from The King’s Fund articulates the benefits of shared decision-making and provides a detailed roadmap for how to effectively implement its use more widely. A great deal of work on creating decision aids and training providers needs to be done.
Tags: Care Management, Consumers, decision-making
2011 Potpourri XXXII
by Kevin Roche on Friday, August 19, 2011
Our thirty-second Potpourri of the year brings fascinating health items such as how to design wellness incentives, how Medicare could save money, the complexities of improving care, the use of community health centers to save money, designing subjective survey questions and an intervention to reduce hospital readmissions.
Tags: Care Management, Health Care Costs, Health Care Quality, Hospital, Malpractice, Medicare, Wellness and Prevention
Review of Care Management Research
by Kevin Roche on Thursday, August 18, 2011
The Agency for Healthcare Research & Quality released a report on the Comparative Effectiveness of Case Management for Adults with Medical Illness and Complex Care Needs. This metareview found limited evidence for positive effects of any care management intervention.
Tags: Care Management, Chronic Disease, Comparative Effectiveness, Elder Care
GAO on the Value of Health Spending
by Kevin Roche on Wednesday, August 3, 2011
The Government Accounting Office examined various interventions designed to improve the quality of health care and/or lower costs and analyzed the strength of the evidence supporting the effect of the intervention. In general, not many interventions have high-quality research results to support efficacy.
Tags: Care Management, Health Care Costs, Health Care Quality
Risk-Bearing by Providers
by Kevin Roche on Monday, August 1, 2011
A recent report from the Commonwealth Fund describes the status of plans to have accountable care organizations and other provider systems take on financial risk for their patients, finding that there is a gap between the plans and the providers capabilities to manage the risk.
Tags: ACO, Care Management, Health Care Costs, Health Insurance, Physicians
2011 Potpourri XXIV
by Kevin Roche on Friday, June 17, 2011
The week’s Potpourri continues the tradition of presenting excellent nuggets of health information, including EHR use in the VA system, the effect of making surrogate care decisions, screening for ovarian cancer, gaps in health among socioeconomic groups, cancer care guideline compliance, and ER visits in Massachusetts.
Tags: Care Management, EHRs, Elder Care, End-of-Life Care, Health Care Costs, Health Care Reform, HIT, Wellness and Prevention
New Ideas to Control Spending
by Kevin Roche on Monday, June 6, 2011
Responding to a challenge for each medical specialty to find methods for reducing inappropriate care and spending in that specialty, two oncologists identify a number of steps that could easily be adopted and are supported by research findings.
2011 Potpourri XXII
by Kevin Roche on Friday, June 3, 2011
Another round of health tidbits, including the association between primary care workforce and Medicare outcomes, comparisons of Type 2 diabetes drugs, effects of limiting DTC drug advertising, health information exchange sustainability, the effect of the Irish workplace smoking ban and barriers to diffusion of cost-effective care.
Tags: Care Management, Drugs, Elder Care, Health Care Costs, Health Care Reform, HIT, Medicare, Physicians, Wellness and Prevention, Workplace
2011 Potpourri XXI
by Kevin Roche on Friday, May 27, 2011
Our Memorial Day Potpourri, celebrating health information such as the growth of high-deductible plans, physician starting salaries, benefit design for high-cost conditions, why emergency room physicians order tests, the use of telehealth for heart failure patients and sources of physician pay.
Tags: Care Management, Chronic Disease, Health Care Costs, Health Insurance, Malpractice, Physicians, Telemedicine
Evidence and Guidelines for Care
by Kevin Roche on Tuesday, May 17, 2011
An editorial in the Journal of Managed Care Pharmacy illustrates common pitfalls in creating guidelines based on certain kinds of research and explains why cause and effect can often be wrongly inferred in the absence of randomized trials.
Tags: Care Management, clinical research, Comparative Effectiveness, Drugs
Guidelines and Good Care
by Kevin Roche on Thursday, May 5, 2011
New research examines the need to use care guidelines carefully, showing the danger of using generalized rules for all patients, and the benefit of tailoring those rules for individual circumstances.
Health Literacy and Outcomes
by Kevin Roche on Tuesday, May 3, 2011
Research published in JAMA examines the extent to which patients’ health literacy is associated with heart failure outcomes, finding a connection in the case of all-cause mortality, but not with hospitalizations.
Hip Replacements
by Kevin Roche on Thursday, April 28, 2011
Hip replacement is one of the most pervasive orthopedic procedures, particularly among older Americans. Research among Medicare beneficiaries reveals trends over 18 years, finding lower mortality, but potential issues on site of discharge and readmissions.
Tags: Care Management, Elder Care, Hospital, Medicare
The Latest Dartmouth Atlas Work
by Kevin Roche on Tuesday, April 26, 2011
The latest Dartmouth Atlas report focuses on trends and variation in end-of-life care, finding fewer people are dying in the hospital, more hospice use is occurring, but intensity of care is increasing.
Tags: Care Management, Elder Care
2011 Potpourri XVII
by Kevin Roche on Friday, April 22, 2011
Happy Easter and welcome to our latest Potpourri, which will raise you up with information on workplace wellness, hospital pricing, clinical decision support systems, using HIT to save on drug development costs, CMS’ quality improvement programs and health care M&A activity.
Tags: Care Management, Drugs, Health Care Quality, HIT, Hospital, M&A, Pay For Performance, Workplace
The VHA and Chronic Disease Care
by Kevin Roche on Thursday, April 21, 2011
A study of the VHA’s care for chronic disease patients finds generally good compliance with treatment recommendations, but not necessarily the best patient outcomes, reflecting the complexity of improving quality.
Tags: Care Management, Chronic Disease, Disease Management, Government, Health Care Quality
GAO Reports on CHIPs Programs
by Kevin Roche on Thursday, April 14, 2011
Medicaid and the Childrens Health Insurance Programs provide coverage for a very substantial portion of the nation’s children. The GAO issues a report on the adequacy of some aspects of the care they receive.
Tags: Care Management, Government, Health Care Costs, Health Care Quality, Medicaid
A Fool’s Potpourri XIV
by Kevin Roche on Friday, April 1, 2011
Every few years April 1st falls on a Friday, allowing us to put out our Potpourri on that day. As you might anticipate, one of our items this week is bogus, and it shouldn’t be too hard to figure out which one.
Tags: Care Management, Drugs, Health Insurance, Physicians, Telemedicine
IOM on Trustworthy Evidence-Based Medicine
by Kevin Roche on Monday, March 28, 2011
The Institute of Medicine puts out two reports related to guidelines and the evidence supporting them which, if followed, should help ensure credible advances in scientific guidance for medical care.
Tags: Care Management, evidence based medicine, Pay For Performance
2011 Potpourri XIII
by Kevin Roche on Friday, March 25, 2011
Another edition of the Potpourri, featuring results on the Guided Care program, bundled payment experience, academic physician compensation, end-of-life care, hospital prices and costs, and geographic variation in Medicare spending.
Tags: Care Management, Chronic Disease, Disease Management, Elder Care, Health Care Costs, Hospital, Physicians
2011 Potpourri XII
by Kevin Roche on Friday, March 18, 2011
Our Ides of March Potpourri, featuring two studies of the impact of wellness programs; the link between hospital spending and mortality outcomes; HHS waiving the MLR requirement for Maine; bills to have CMS disclose physician practice patterns; and research on smoking cessation techniques.
Tags: Care Management, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, Hospital, Medicare, Wellness and Prevention, Wireless
2011 Potpourri X
by Kevin Roche on Friday, March 4, 2011
Hopefully winter nears its end; it has been brutal where we are. This week’s Potpourri may offer a little diversion, covering defensive medicine, a pediatric tele-consultation service, home stroke rehabilitation, consumers’ ability to afford care, patient satisfaction and hospital readmission rates and a mobile phone app to improve medication adherence.
Tags: Care Management, Drugs, Health Care Costs, HomeCare, Hospital, Telehealth
2011 Potpourri VII
by Kevin Roche on Friday, February 11, 2011
Another rendition of selections from the health literature, including advance directive issues; guideline problems; physician religious beliefs and end-of-life care; health information exchanges; the results of use of modified global payments with physicians and hospitals; and physician payment reform.
Tags: Care Management, Elder Care, HIT, Medicare, Physicians
2011 Potpourri VI
by Kevin Roche on Friday, February 4, 2011
Our usual end-of-the-week collection of health care tidbits, featuring HIE vendor awards; the point-of-care testing market; what makes medical groups successful; family caregivers and technology; clinical decision software for imaging; health care employee compensation; and communication between primary care and specialist physicians.
Tags: Care Management, Elder Care, HIT, Medical Care, Physicians
AHRQ Review of Clinical Decision Support
by Kevin Roche on Tuesday, February 1, 2011
An AHRQ report focuses on the evidence for the value of clinical decision support systems, finding strong evidence that they improve care processes but limited evidence for health or cost outcome improvement. The report also identifies features correlated with CDS success.
Tags: Care Management, HIT, Physicians
One Perspective on Health Care’s Future
by Kevin Roche on Wednesday, January 19, 2011
CSC put out a report giving its vision of the future of health care, with a particular focus on how emerging technologies may reshape wellness, prevention, early disease detection, treatment and how care is delivered.
Tags: Care Management, Health Care Costs, Health Care Quality, HIT, Medical Care, Wellness and Prevention
Use and Misuse of Imaging
by Kevin Roche on Tuesday, December 21, 2010
Health Affairs carries several articles analyzing imaging use, particularly in regard to physician interests in imaging equipment. The findings support the idea that physicians are often driven by their own economic advantage when making decisions about patient treatment.
Tags: Care Management, Health Care Costs, Health Care Quality, Physicians
2010 Potpourri XLIV
by Kevin Roche on Saturday, December 18, 2010
Another week, another Potpourri, this one detailing items including high deductible insurance and delay of care; another study looking at HDHP and well-child care; a quality comparison of Medicare Advantage and fee-for-service; video games to improve health and CMS’ report on several quality demonstrations.
Tags: Care Management, Consumers, Health Care Quality, HIT, Medicare
Medical Home Value Evidence
by Kevin Roche on Wednesday, December 15, 2010
Research continues to accumulate suggesting that the patient-centered medical home can save money while improving care and patient satisfaction. A new report summarizes this evidence, but the applicability of the model across the entire system has yet to be demonstrated.
Tags: Care Management, Medical Care, medical home, Physicians
Personalized Medicine Reimbursement
by Kevin Roche on Friday, December 10, 2010
Personalized medicine sometimes gets lost in the debate over other major health care issues, but it is probably the single most significant development in the actual delivery of medical care and will be so for the next decade. A new report details reimbursement hurdles to growth of the field.
Tags: Care Management, Genomics, Personalized Medicine, Regulation
TeleCare in the ICU
by Kevin Roche on Monday, December 6, 2010
New research from the New England Healthcare Institute examines use of telemonitoring of ICU patients and finds that it produces good outcomes and could create substantial cost savings in the state of Massachusetts alone.
Tags: Care Management, Hospital, Telemedicine
Communications Technology and Weight Loss
by Kevin Roche on Thursday, December 2, 2010
An article in Telemedicine and eHealth reviewed a number of technology based or assisted weight management programs to determine if they appeared effective and what the characteristics were of successful programs.
Tags: Care Management, Telemedicine
New Evidence on Wellness Value
by Kevin Roche on Tuesday, November 30, 2010
Doubt continues to exist about whether wellness and prevention have net short or long-term cost savings. A new study indicates that a well-designed, comprehensive health program can save money, at least in the near term, and may lower longer term cost trajectories.
Tags: Care Management, Consumers, Health Care Costs, Wellness and Prevention
Turkey of a Potpourri
by Kevin Roche on Thursday, November 25, 2010
There you are, relaxing on a holiday and holiday weekend and for some reason you feel compelled to browse the internet and come across our Thanksgiving potpourri, hopefully not a turkey, but stuffed with edible data, including HHS’ final rule on MLRs; the AMAs survey on prior authorization; principles for ACOs, how to use research studies, Humana’s acquisition of Concentra and an explanation of why health care costs keep going up. Happy Thanksgiving!
Tags: Accountable Care Organization, Care Management, Health Care Costs, Health Insurance, HIT, M&A, MLR, Physicians, Workplace
GAO on Integrated Delivery Systems
by Kevin Roche on Tuesday, November 23, 2010
The Government Accounting Office interviewed representatives of a number of integrated provider systems to ascertain features, purported benefits in assisting underserved populations and challenges to the success of the organizations.
Tags: Care Management, Hospital, Physicians
Does Telemonitoring of Health Failure Improve Outcomes?
by Kevin Roche on Monday, November 22, 2010
New research reported in the NEJM finds that telemonitoring of recently discharged heart failure patients did not result in better outcomes than did usual care, but characteristics of the study and analysis mean that the results should not be over-interpreted.
Care Management for the Elderly Patient
by Kevin Roche on Wednesday, November 17, 2010
Older Americans have a high rate of chronic disease and those patients are responsible for much of overall health spending. An article in JAMA explores programs designed to manage care better for these patients.
Tags: Care Management, Chronic Disease, Elder Care, Medicare
Telecare for Arthritis
by Kevin Roche on Thursday, November 11, 2010
Studies continue to show the value of telecommunications technology in lowering the cost of managing chronic disease while improving outcomes. A study in the Annals of Internal Medicine reports on telephonic support for self-management of osteoarthritis.
Tags: Care Management, Consumers, Telemedicine
End-of-Life Care
by Kevin Roche on Monday, November 8, 2010
New research covering aspects of end-of-life care in Canada and the US reveals that costs continue to be high, even though the use of palliative care in the United States has increased significantly.
2010 Potpourri XL
by Kevin Roche on Saturday, October 30, 2010
Is there anything scary about health care? Yes if you have to pay for it! Nothing scary about our Potpourri, just soothing health care nuggets, covering alternative therapies for back pain, CBO’s view on the reform law, peer interaction to help manage diabetes, diabetes prevalence, Massachusetts physician information, accountable care organizations, bias in clinical trial results and the effects of the health law on employer provided insurance.
Tags: Accountable Care Organization, Care Management, Chronic Disease, Disease Management, Health Care Costs, Health Care Reform, Health Insurance, Medical Care, Physicians, Workplace
Paper on Accountable Care Organizations
by Kevin Roche on Friday, October 29, 2010
CSC put out a White Paper on Health Information Requirements for Accountable Care which examines the necessary functions an effective ACO will have and what health information technology will be needed to support those functions.
Tags: Care Management, HIT, Providers
Home Is Where the Care Is
by Kevin Roche on Thursday, October 28, 2010
The complexity and rate of change in health care sometimes makes spotting major trends difficult. One appears to be growth of home-based diagnostic and therapeutic care. An article in the New England Journal of Medicine discusses drivers for this trend.
Tags: Care Management, Consumers, Health Care Costs, Health Care Quality, HomeCare, Telemedicine
Nursing Home Resident Hospitalizations
by Kevin Roche on Tuesday, October 26, 2010
There is so much health spending in the United States that it is sometimes hard to isolate the big buckets. Nursing home residents have very high medical costs and many questionable hospitalizations. A KFF report examines reasons why.
Tags: Care Management, Elder Care, Health Care Costs, Physicians
2010 Potpourri XXXIX
by Kevin Roche on Saturday, October 23, 2010
The leaves disappear from the trees but our Potpourri is eternal, this week entertaining you on projected drug spending next year, prescription abandonment rates, avoiding hospitalizations for home care patients, anticipating the effects of the health law on employer-provided health insurance, the NAIC’s final action on the MLR and hospitals views on their ability to achieve the meaningful use incentives.
Tags: Care Management, Drugs, Health Care Reform, Health Insurance, HIT
Home Testing of Blood Thinning Medication
by Kevin Roche on Friday, October 22, 2010
Research reported in the NEJM looked at differences in quality of care for patients who either tested themselves at home or were tested in a clinic to guide the administration of warfarin, a blood thinning drug. The results indicate home testing is as good as clinic testing.
Tags: Care Management, Consumers, HomeCare
Process of Care and Health Outcomes
by Kevin Roche on Wednesday, October 20, 2010
As the use of pay-for-reporting and pay-for-performance grows, there is more research into whether care processes being measured are really related to ultimate health outcomes. A new article says not necessarily.
Tags: Care Management, Health Care Quality, Hospital, Medicare, Pay For Performance
2010 Potpourri XXXVI
by Kevin Roche on Saturday, October 2, 2010
The days shorten but the potpourri stays strong, this week including information on the safety of FDA-cleared devices; medication adherence; genetic tests; the FDA and CMS working together to review products; state all-payer databases and the increasing control of physician practices by hospital systems.
Tags: Care Management, Devices, Drugs, Health Care Costs, HIT, Hospital, Medicare, Personalized Medicine, Physicians, Regulation
New Papers on the Medical Home
by Kevin Roche on Thursday, September 30, 2010
Two recent publications explore the potential of widespread use of the medical home concept to create better primary care and coordination of overall care for patients, and examine barriers and challenges for adoption.
Telephone Care Management Support
by Kevin Roche on Wednesday, September 29, 2010
A study published in the New England Journal of Medicine gives heart to supporters of telephone-based care management programs. Largely because of reduced hospitalizations, patients in the intervention arm had lower monthly medical costs, for a modest price.
Tags: Care Management, Chronic Disease, Health Care Costs, Telemedicine
Telemedicine for Hypertension
by Kevin Roche on Tuesday, September 28, 2010
Telemedicine is being applied to many diseases and conditions and telemonitoring is spreading as a core component of self-management of health and a method to ensure greater continuity of care. A survey of studies on telemonitoring for hypertension finds improved outcomes.
Tags: Care Management, Telemedicine
CBO on Obesity
by Kevin Roche on Monday, September 20, 2010
Obesity has been fingered as one of the villains of health care cost increases. A CBO analysis verifies that obese persons appear to have significantly higher annual health care costs compared to non-obese persons.
Tags: Care Management, Chronic Disease, Consumers, Health Care Costs
Hospital Process of Care Measures and Outcomes
by Kevin Roche on Tuesday, September 7, 2010
A new study of the association between process of care measures and health outcomes for certain hospital episodes has encouraging results for pay for reporting and pay for performance programs.
Medical Home Value
by Kevin Roche on Monday, August 30, 2010
A study of a medical home model indicates reductions in hospital admissions and readmissions and possibly a reduction in total spending. It is not clear, however, what the full economic impact was nor is it clear that most practices would see the results that this particular provider system did.
Tags: Care Management, medical home, Physicians
2010 Potpourri XXXI
by Kevin Roche on Saturday, August 28, 2010
Summer nears an end, but not our Potpourris. This one includes the costs of malpractice, an innovative provider error disclosure program, employer wellness paybacks, blood pressure medication issues, the cost of new technologies, provider pricing power and the mental health of Californians.
Tags: Care Management, Health Care Costs, Hospital, Malpractice, Personalized Medicine, Wellness and Prevention
More On Palliative Care
by Kevin Roche on Wednesday, August 25, 2010
Palliative care has been extensively researched and the results indicate greater quality of life and patient satisfaction for persons with terminal illness. New research suggests it also extends survival.
2010 Potpourri XXIX
by Kevin Roche on Saturday, August 14, 2010
Another Saturday, another Potpourri, featuring the acquisition of a hospital medical necessity company, Americans’ online health usage, analysis of prescriptions, California workers’ compensation, home monitoring of elderly parents, remote psychiatric evaluations and telemedicine to treat depression.
Tags: Care Management, Drugs, Elder Care, HIT, HomeCare, Medicare, Monitoring, Telemedicine, Workers Compensation
Telemedicine and Cancer Care
by Kevin Roche on Friday, July 16, 2010
A study reported in JAMA examines the use of telemedicine techniques to improve the management of pain and depression in cancer patients.
Tags: Care Management, Telemedicine
End-of-Life Care and Patients’ Preferences
by Kevin Roche on Monday, July 12, 2010
Medical care provided near the end of a patient’s life accounts for a significant portion of total national health spending and is often inconsistent with patient wishes. New research evaluates the effects of a more detailed set of physician advance orders for frail and elderly persons.
2010 Potpourri XXIV
by Kevin Roche on Saturday, July 10, 2010
Sitting indoors seeking relief from the summer heat? Here’s a montage of cool and refreshing health care items, including CPOE systems, accountable care organizations, Massachusetts’ reform experience, reducing imaging, and medical management trends.
Tags: Care Management, Government, Health Care Reform, HIT, Hospital, Medical Care
Encouraging People to Get Necessary Services
by Kevin Roche on Thursday, July 8, 2010
Preventive measures can help patients delay or prevent illness or can lead to early detection and usually better outcomes. Unfortunately many patients fail to take even the most basic preventive steps. A new study suggests just how difficult it is to change that behavior.
Better Followup May Not Prevent Hospital Readmissions
by Kevin Roche on Tuesday, June 29, 2010
A common perception is that there are too many hospital readmissions which could be prevented with better discharge planning. A new study indicates that scheduling follow-up visits may not help prevent readmissions, most of which are unrelated to the original admisssion in any event.
Tags: Care Management, Hospital
Group Medical Visits
by Kevin Roche on Wednesday, June 9, 2010
As long as cost pressures continue, people will search for new and better ways to control them. One area of focus has been the cost of a physician interaction and group visits are an emerging approach to reduce that cost.
Specialists as Patient Care Coordinators
by Kevin Roche on Tuesday, May 4, 2010
Specialist physicians are often blamed for the fragmented and expensive nature of American medical care. A perspective in the NEJM explores whether they might appropriately serve as principal physicians in the patient centered medical home models.
Tags: Care Management, Physicians
Self-Directed Care
by Kevin Roche on Friday, April 30, 2010
Here’s a novel idea–give patients a set amount of money to spend on health care needs and allow them to manage what services they use for that money. It is a notion that is spreading internationally and just represents an attempt to restore traditional economics to health care.
Tags: Care Management, Consumer Directed Health, Health Care Costs
2010 Potpourri XIII
by Kevin Roche on Saturday, April 17, 2010
More exotic gleamings from the world of health care, including self-directed care, telemedicine, point-of-care diagnostics, HCA, doctor-patient interactions and socio-economic factors in health outcomes.
Tags: Care Management, Consumers, Diagnostics, Health Care Quality, Physicians, Telemedicine
More Imaging Issues
by Kevin Roche on Tuesday, March 16, 2010
Use of imaging services has become the poster child for health care spending problems, even though excessive imaging may have been rather rapidly controlled by private sector use of imaging benefit managers. New research pours salt on the wounds.
Tags: Care Management, Health Care Costs
More on Regional Spending Variation
by Kevin Roche on Tuesday, February 23, 2010
The New England Journal of Medicine publishes dueling commentaries on geographic and provider spending variations. Having a clear understanding of whether there are providers who render more care with no better outcomes would help formulate reforms to change their behavior.
Medco Acquires DNA Direct
by Kevin Roche on Thursday, February 11, 2010
Medco’s acquisition of DNA Direct, a genetic testing management company, may be a reaction to an earlier CVS Caremark transaction, but is also a recognition of the looming flood of genomic information and products that will usher in the era of personalized medicine.
Tags: Care Management, M&A, Personalized Medicine
2010 Potpourri IV
by Kevin Roche on Saturday, February 6, 2010
Yet another sampling of health care items, relating to personalized medicine, telemedicine, wellness, disease management and using health data for comparative effectiveness research.
Tags: Care Management, Comparative Effectiveness, Personalized Medicine, Telemedicine, Wellness and Prevention
2010 Potpourri III
by Kevin Roche on Saturday, January 23, 2010
Healthy health care snacks–concierge medicine, personalized medicine, health care hiring, electronic medical records, Medicaid, disease management–all for your reading pleasure on the weekend.
Tags: Care Management, Chronic Disease, Disease Management, HIT, Medical Care, Personalized Medicine, Physician Practice Models, Physicians
Managing End-of-Life Care
by Kevin Roche on Monday, January 18, 2010
End-of-life care achieved some notoriety in the health reform debate, but it deserves thoughtful attention since it accounts for a great deal of cost and research indicates that patients’ wishes for less intensive care are often not honored. A new study looks at how physicians approach the issue.
Tags: Care Management, Medicare, Physicians
Disease Management Works If You Give It Time.
by Kevin Roche on Thursday, January 14, 2010
Skepticism has increased regarding the ability of disease management programs to create cost savings. A new white paper indicates that if the analysis is conducted over a multi-year period, savings are more likely to be found.
Weekend Potpourri VIII
by Kevin Roche on Saturday, December 19, 2009
More health care snippets, including hospital costs, wireless health in 2009, genetic testing, caring for the elderly and pay-for-performance programs. Bon Apetit!
Tags: Care Management, Pay For Performance, Personalized Medicine, Wireless
Patients More Cautious When Personally Making Medical Decisions
by Kevin Roche on Wednesday, December 2, 2009
Researchers looked at patients’ decision-making when they were hearing a very strong physician recommendation versus when they were solely responsible for a medical decision. The patients were more risk-avoiding than the physicians.
Remote Monitoring of Heart Failure Patients
by Kevin Roche on Wednesday, November 11, 2009
The Journal of the American College of Cardiology published a meta-analysis of usual care for heart failure patients versus regular telephone follow-up or remote electronic monitoring, finding that the latter approaches reduced hospitalizations and death.
Weekend Potpourri II
by Kevin Roche on Saturday, October 31, 2009
Another edition of our thrilling, perhaps even chilling collection of health care tidbits for your Halloween edification.
Tags: Care Management, Medical Care
Weekend Potpourri
by Kevin Roche on Saturday, October 24, 2009
A miscellany of interesting items for your weekend browsing pleasure.
Tags: Care Management, Government, Health Care Costs, Health Care Reform, Telemedicine
The Society for Participatory Medicine
by Kevin Roche on Wednesday, October 21, 2009
The Society for Participatory Medicine is starting a journal focused on shared decision making and other aspects of patient engagement in their medical care.
Use of Mobile Health Tools for Chronic Illness
by Kevin Roche on Wednesday, October 21, 2009
The California HealthCare Foundation releases a report on Participatory Health, which provides an introduction to the potential of online and mobile technologies in management of chronic illness.
Tags: Care Management, Chronic Disease, Devices, Medical Care, Telemedicine
More Variation in Spending Research
by Kevin Roche on Monday, October 19, 2009
A study reported in Circulation indicates that California teaching hospitals that utilize more resources in treating heart failure had lower rates of mortality. The study results call into question the methods and findings of some Dartmouth Atlas research. Another report looks at supply and variation in MRI usage.
Tags: Care Management, Health Care Costs, Hospital, Medical Care, Providers
More News on Medicare Advantage’s Advantages
by Kevin Roche on Friday, October 2, 2009
Another study demonstrates quality performance and better cost benefits from Medicare Advantage plans.
Tags: Care Management, Government, Health Insurance, Medicare
House Calls Returning?
by Kevin Roche on Tuesday, September 15, 2009
The Los Angeles Times reports on a possible return of house calls.
Tags: Care Management, Medical Care, Physicians, Providers
Measuring Prevention’s Cost Savings
by Kevin Roche on Tuesday, September 8, 2009
A new Health Affairs article suggests a different method to measure cost savings from disease prevention and management efforts.
Tags: Care Management, Chronic Disease, Medical Care, Wellness and Prevention
Home Medical Testing and the Self-Care Movement
by Kevin Roche on Wednesday, September 2, 2009
Patients are increasingly involved in the management of their own health.
Tags: Care Management, Consumers, Medical Care, Patients
Hypertension Treatment Status
by Kevin Roche on Tuesday, September 1, 2009
There are excellent hypertension treatments available but many Americans don’t know they have the condition and aren’t being treated.
Quality Improvement is Not Easy
by Kevin Roche on Thursday, August 27, 2009
A commentary on Medicare’s experience in attempting to improve the quality of heart failure care demonstrates just how hard it may be to get better outcomes and lower cost.
Do We Really Need Another Reminder About the Problems With Government Health Programs?
by Kevin Roche on Tuesday, August 25, 2009
USA Today published an article on the federal end-stage renal disease program. The problems are typical of most government health programs.
Tags: Care Management, Chronic Disease, Government
NEHI Study Estimates Cost of Medication Non-Compliance
by Kevin Roche on Wednesday, August 19, 2009
A recent report from NEHI states that medication therapy non-compliance leads to $290 billion in avoidable medical costs every year.
Tags: Care Management, Drugs, Health Care Costs, Pharmaceutical
Vertebral Fracture Treatment Studies
by Kevin Roche on Thursday, August 6, 2009
Two studies question the value of a vertebral fracture treatment, but more importantly show the utility of comparative effectiveness research.
Tags: Care Management, Comparative Effectiveness, Medical Care
Patient Involvement Is A Key to Real Reform
by Kevin Roche on Wednesday, August 5, 2009
Research and experience continues to confirm the value, in both cost savings and patient satisfaction, of extensive patient involvement in important health decisions.
Tags: Care Management, Consumer Directed Health, Consumers, Medical Care
Wireless Explosion
by Kevin Roche on Wednesday, August 5, 2009
A number of companies are working on use of wireless technologies to improve health care.
Tags: Care Management, Devices, HIT
Telemedicine Utility and Barriers
by Kevin Roche on Thursday, July 2, 2009
Experts are recommending greater use of telemedicine in stroke assessment and treatment. There are significant barriers, however, many imposed by government.
Tags: Care Management, Health Insurance, Medical Care, Telemedicine
Shared Decision Making
by Kevin Roche on Tuesday, June 23, 2009
Shared decision-making for preference-sensitive conditions has the potential to improve quality and control spending. States are exploring required use of the technique and it should be considered in federal reform efforts.
Tags: Care Management, Consumers, Health Care Costs, Health Care Quality, Health Insurance
The Value of Care Management
by Kevin Roche on Thursday, May 21, 2009
A recent article in The American Journal of Managed Care (volume 15, page 295, May 2009), described findings from a comparison within the Kaiser Permanente system of patients with diabetes who were subject to a care management program and those who were not.
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