Making It Stick : June 2007 HR Executive - Carolyn Hirschman In employers' war against rising health-care costs, one major battle is getting employees to get healthy and stay that way. For all its difficulty, it's a battle worth fighting, experts say, because better health can nip costs in the bud and raise productivity. Article features programs at Dow Chemical and SCANA.

Reducing Patient Drug Acquisition Costs Can Lower Diabetes Health Claims : August 2005 American Journal of Managed Care - John J. Mahoney MD

Direct medical costs for diabetes and related complications are notoriously high....disease-related work absences and disability account for about one third of the total cost per employee with diabetes.

Fortunately, investing in aggressive diabetes control not only improves blood glucose levels but reduces medical complications and costs and may also boost productivity and lower absenteeism.

Prescription Drug Cost Sharing: Associations With Medication and Medical Utilization and Spending and Health (Abstract) : July 2007 Managed Care Interface - Dana P Goldman PhD; Geoffrey F. Joyce PhD; Yuhui Zheng, MPhil

"....Increased cost sharing is associated with lower rates of drug treatment, worse adherence among existing users, and more frequent discontinuation of therapy. For each 10% increase in cost sharing, prescription drug spending decreases by 2% to 6%, depending on class of drug and condition of the patient....For some chronic conditions, higher cost sharing is associated with increased use of medical services, at least for patients with congestive heart failure, lipid disorders, diabetes, and schizophrenia...."

Lowering Patient Drug Acquisition Costs to Improve Health Outcomes and Costs : April 2006 Managed Care Interface - John J. Mahoney MD

"Cost is a barrier that can lead to delayed treatment or failure to follow a prescribed course of treatment....This can be especially important for conditions that require ongoing medical management, such as asthma, diabetes, and hypertension."


CostRx: Investing in Human Assets : 2006 UPI (John J. Mahoney interview)

"A few years ago postal-products giant Pitney Bowes revamped its health-benefits structure with a primary principle in mind: Pay more up front to keep chronic conditions like diabetes in check among the company's workforce, or pay much more later when an uncontrolled disease balloons into a costly drag on the company's bottom line -- both in terms of direct medical costs and the often greater indirect costs, including absenteeism, short-term disability and "presenteeism," where an employee with a chronic condition like asthma reports to work but cannot give 100 percent to the job."

Integrated Health and Productivity: An Essential (Winning) Strategy in Today’s Competitive Environment : Aon

"...it is time to reassess failed cost management attitudes and strategies. An integrated health and productivity program may be the best prescription for many employers."

Employers' Stock in Wellness Rises with No End in Sight : July 2006 Managed Care Magazine - Martin Sipkoff

"We are creating a culture of wellness by addressing tangible behaviors, like smoking and obesity, and we are continually breaking new ground," says Pitney Bowes CEO Michael J. Critelli about his self-insured company's wellness initiatives. "When our employees become ill, it directly affects our bottom line, so our idea is a complete alignment of incentives between the company, the employee and the providers and plans."

Health, Absence, Disability, and Presenteeism Cost Estimates of Certain Physical and Mental Health Conditions Affecting U.S. Employers : April 2004 Journal of Occupational and Environmental Medicine - Ron Z. Goetzel et al

"Evidence about the total cost of health, absence, short-term disability, and productivity losses was synthesized for 10 health conditions. Cost estimates from a large medical/absence database were combined with findings from several published productivity surveys."

Presenteeism: At Work - But Out of IT : October 2004 Harvard Business Review - Paul Hemp

Woody Allen once said that 80% of success in life can be attributed to simply showing up. But a growing body of research indicates that - in the workplace, at least - this wry estimate may be somewhat optimistic. Researchers say that presenteeism - the problem of workers' being on the job but, because of illness or other medical conditions, not fully functioning - can cut individual productivity by one-third or more."

Hidden Epidemic: Finding a Cure for Unfilled Prescriptions and Missed Doses : Boston Consulting Group 2003

Each year, millions of patients in the United States fail to comply with their physicians’ prescribed drug regimens, jeopardizing their health in the process.

Contrary to beliefs widely held throughout the health care industry, however, the primary reason why people fail to take their medicine is not memory loss.....

More Employers Link Health Risk Appraisals To Open Enrollment
Employee Benefit News :: February 26, 2008 :: Article - 1 page
(free registration or data entry required)

"53% of companies report they included or will include by 2009 an HRA in their benefit enrollment process, while 36% use open enrollment to encourage employees to sign up for disease management programs or will do so by 2009, reports Watson Wyatt." ....only 27% [of employers] have incorporated [their benefits enrollment information] with their health care provider's system, which often stores robust information on disease management and healthy lifestyles...."

Malpractice Insurer Offers Physicians A Discount
Portland Business Journal :: Portland, Oregon :: February 21, 2008 :: Article - 1 page
(immediate access)

Northwest Physicians Insurance Co., one of Oregon's largest medical liability carriers, is offering discounts to doctors that use computerized personal health records and e-mail to communicate with patients. Depending upon medical specialty, the discounts range from $375 to $2,250 annually. That's potentially greater than the cost of the secure e-mail or personal health record system, which cost approximately $1 per doctor per day....

On-Site Clinic Healthy For Bottom Line
Lawrence Journal World & News :: Lawrence, Kansas :: February 17, 2008 :: Article - 1 page
(immediate access)

Now entering its fifth year at Amarr [Garage Doors] in Lawrence, the program ranks among the most popular benefits for employees, and most economical and high-payoff programs for the company, said Kirsten Krug, who works in the Lawrence plant and oversees human resources for North Carolina-based Amarr....

Wellness Programs Seen as Way To Stop The Bleeding In Health Care Costs
San Diego Business Journal :: San Diego, California :: March 26, 2007 :: Article - 1 page
(immediate access)

Area employers sickened by rising health care costs may find relief in a growing number of wellness programs for employees. Del Mar Heights broker Intercare Insurance Solutions reports that the average price of group health plans has increased 73 percent in the past five years, a quarter of which was preventable, said Dr. Terry Fouts, senior vice president for Great-West Healthcare.... ....John Kahle, chief wellness officer for Intercare, said, “the mindset change from health care as an expense to health care as an investment” is coming. Fouts was in town last week at Intercare’s invitation to speak to 90 employers, representing 40,000 workers. The audience also heard from David Hom, vice president of strategic initiatives for Pitney Bowes Inc., a document management service company in Connecticut.

Lower Co-Pays Make Patients Less Likely To Skip Meds
Wall Street Journal - Health Blog :: January 8, 2008 :: Blog post - 1 page
(paid subscription required)

“My mother said, ‘I can’t believe you had to spend all this money to find out if you make people spend more for something, they’ll buy less of it.’ ” That’s what Mark Fendrick, a professor of medicine and health policy at the University of Michigan, told us today when we got him on the phone to discuss his study published in the current issue of Health Affairs.... ...The study was funded by GlaxoSmithKline and Pfizer, and was conducted in part by ActiveHealth, an Aetna subsidiary that designs the kind of plans Fendrick is talking about. Fendrick consults to ActiveHealth and receives research funding from lots of drug companies.

More Health Plans Strategically Manage Diabetes
Employee Benefit News :: December 20, 2007 :: -
(immediate access)

Evidence is growing that effective management of diabetes can reduce complications and health care costs, while boosting employee productivity, reports the National Business Coalition on Health, which recently released a study on health plans and diabetes performance....There are promising initiatives underway that could help employers better manage diabetes, NBCH says, including value-based benefit design plans – which identify incentives to increase compliance while maintaining cost sharing – and interoperable health information technology and quality and price transparency.



Link to the eValue8 study: "Health Plan Diabetes Care Performance"

Partners In Quality: Gulfstream, Memorial Initiative Adding Up To Lower Costs, Improved Health Care
Savannah Morning News :: Savannah, Georgia :: December 9, 2007 :: Article - 1 page
(immediate access)

Nearly five years ago, Bob Holben made what was, for him, a startling discovery. The director of compensation and benefits for Gulfstream Aerospace had been doing research on new ways to help contain the spiraling costs of health care for Gulfstream's more than 5,000 area employees when he came across several national studies that suggested as much as 30 percent of all health care costs in the country could be traced back to poor- quality decisions....Together, Memorial and Gulfstream formed Partners in Quality, a program designed to improve the quality of health care provided to employees in the Savannah area, reduce health care costs, and share the resulting cost savings with the physicians who use best practice protocols.

Can Insurer, Oncology Practice Really Work Together?
Managed Care Magazine :: October 1, 2007 :: Article - 1 page
(immediate access)

Premera Blue Cross and a large Spokane oncology practice agree on treatment protocols and on the importance of cost control As the cancer-treatment landscape changes — promising longer, healthier lives for patients but with the side effect of astronomical costs — most health plans and oncologists are locked in a stare-down to see who has the most power. But one large oncology practice and the dominant insurer in its market have found another way to do business together. Premera Blue Cross, the largest health plan in Washington and Alaska, and Cancer Care Northwest (CCNW), the largest oncology practice in Spokane, are in the fourth year of a contract that pays oncologists for a new range of responsibilities, with the goal of improving patient outcomes while reducing overall costs.... ....Dave Johnson, MD, Premera's regional medical director in Spokane, and Cutter believe they are testing a model that will become the standard relationship between payers and providers. Although the long-term financial ramifications of their arrangement is not yet fully understood, both parties are optimistic; indeed, both the oncology practice and the health plan are looking into other possible collaborations with other payers and providers, respectively, to enter into similar contracts.

When Patient Calls At Year's End, So Do The Ills Of The Health System
Wall Street Journal :: November 27, 2007 :: Column - 1 page
(paid subscription required)

....We didn't design this patchwork system with perverse incentives and disincentives to care, but we're dealing with it.... As the year closes out, I'm also seeing more self-insured patients with chronic diseases avoiding care. A patient in his 30s has asthma and allergies that have been acting up. He could really use a flu shot, a pneumonia vaccine and a breathing test called spirometry to help us better manage his asthma. I haven't seen him since last fall but he wants medications refilled for a year without a check-up and without being seen. He's been healthy enough to avoid the doctor or the hospital this year and is trying to make it to the end of the year. He tried the same thing last year. He's avoiding the preventive care and advice that would lower his risk of hospitalization because of the deductible costs and lost income from work to come to the office.....

Value-Based Health Embraces Consumerism; Ditches High-Deductible
Employee Benefit News :: November 13, 2007 :: Article - 1 page
(immediate access)

Not all consumer-driven health plans need to have a high-deductible feature to ensure that patients are effectively managing their health care costs. Instead, a growing contingency of health care professionals are promoting value-based benefit packages as a potential solution to the health care crisis. Under such plans, out-of-pocket costs are adjusted based on an assessment of a clinical benefit on a specific patient population. Therefore, the more clinically viable the therapy is for the patient, the lower the cost should be. “Consumer-driven health involves giving [employees] the right incentives,” Andrew Webber, president and CEO of the National Business Coalition on Health, said at the 12th Annual NBCH’s conference in Phoenix. “In some instances, it’s lowering out-of-pocket expenditures. We need to encourage them to select better services and providers.” ....

Better Sharing Of Health Claims Data Needed: NBCH
Business Insurance :: Scottsdale, Arizona :: November 13, 2007 :: Article - 1 page
(immediate access)

Health plans could do a better job of sharing information with employers to enable improvements in patient safety, care coordination and consumerism, according to the eValue8 report on health plan performance released this week by the National Business Coalition on Health....

Among the significant findings in the report, “Connecting the Dots in Health Care,” are: ....Although health plans said they have the ability to implement value-based plan designs to encourage members to obtain needed care, only 38% of health plans indicated they currently modify copayments for pharmaceuticals, tests and/or equipment for diabetics, and only 28% modify deductibles....

A Health Plan For Wal-Mart: Less Stinginess
New York Times :: November 13, 2007 :: Article - 1 page
(free registration or data entry required)

For much of the last decade, the retailing behemoth Wal-Mart Stores has been associated with stingy health care as much as low prices.... ....But in wide-ranging conversations with federal officials like Dr. Julie L. Gerberding, director of the Centers for Disease Control and Prevention, and executives like Michael J. Critelli, the executive chairman of Pitney Bowes, best known for making postage meters but also a leader in employee health care, Wal-Mart’s executives began revising how they thought about benefits.... ....Wal-Mart “went through an evolution that we went through 17 or 18 years ago,” Mr. Critelli said. Pitney Bowes had tried to shift more health costs onto employees, only to find that after a certain point, “it gets dysfunctional,” he said. He and others persuaded Ms. Dillman to think of health benefits as an investment in the work force rather than as a cost....

A Model For Health Care That Pays For Quality
New York Times :: October 7, 2007 :: Article - 1 page
(free registration or data entry required)

Seeing low fees for family doctors as a weak link in the nation’s health care system, some big employers and health insurers are seeking new ways to pay doctors to reward high-quality medical care.... ....Doctors would also be compensated for helping patients manage chronic conditions — like reminding diabetic people to take their insulin — and would be encouraged to transmit prescriptions electronically. The group proposing this model, the National Committee for Quality Assurance, a nonprofit organization focused on health care, plans to present its plan today in Washington at a big meeting of doctors, insurers and employers that provide health benefits.... ....“We are empowering doctors to once again have a doctor-patient relationship,” said Dr. Paul H. Grundy, I.B.M.’s director for Health Care Technology and Strategic Initiatives, who is marshaling support for the changes.

Dr. Grundy is a member of the Center's Board of Advisors.

Treating Diabetes And Understanding Cultures
Wall Street Journal :: October 23, 2007 :: Article - 1 page
(paid subscription required)

With minorities accounting for nearly a third of the U.S. population, medical professionals are beginning to bone up on so-called cultural competency, part of an effort to ensure that patients from disparate backgrounds get proper care. Nowhere is the challenge more acute than for those treating diabetics, given the rising incidence of the disease, its prevalence among minority groups and the changes in diet and lifestyle that treatment often entails....

Companies Forming Own Health Clinics
Milwaukee Journal Sentinel :: Milwaukee, Wisconsin :: October 7, 2007 :: Article - 1 page
(immediate access)

[Dr. Peter] Krause's new practice is at Kohl's Wellness Center, a family-practice clinic less than a half a mile from the company's corporate headquarters in Menomonee Falls.... ....The clinic, which opened in July, is one of at least eight in Wisconsin run by companies. It also is part of a growing trend in which large companies try to rein in rising health care costs by providing the care themselves. Many of those companies - including Quad/Graphics, one of the first to set up its own clinics - have shown that they can provide better care at a lower overall cost..... ....Other Wisconsin companies that have set up primary care clinics for employees and family members include Miller Brewing Co., Briggs & Stratton Corp., InSinkErator, S.C. Johnson and Mercury Marine.

Quad/Graphics' Ray Zastrow is a Board member.

Growing Number Of Employees Face Quizzes About Their Health
Newark Star-Ledger :: Newark, New Jersey :: October 9, 2007 :: Article - 1 page
(immediate access)

"The whole point is to prevent disease development and curb es calating health-care costs. You tar get people who need intervention and try to prevent a catastrophic event," said Debra Draper, associate director of the [Center for Studying Health System Change], which is based in Washington. Other efforts follow people with chronic disease to try to reduce complications. There is no evidence yet that employers get a return on their investment, Draper said.

Health Risks Can Cost Workers
USA Today, originated by Associated Press :: September 10, 2007 :: AP Article - 1 page
(immediate access)

....companies are penalizing workers who have high health risks, such as obesity and high blood pressure or cholesterol, as insurance costs climb.... Employers wary of risking legal problems feel more confident after federal regulations were finalized July 1 covering how wellness programs can comply with non-discrimination requirements under the Health Insurance Portability and Accountability Act. Rewards based on health factors cannot exceed 20% of the total cost of employee health coverage. A small number of companies have linked health factors to what employees pay for benefits, but the practice is expected to grow now that some federal rules have been finalized, spelling out what's allowed by law.

Store Chain’s Test Concludes That Nutrition Sells
New York Times :: September 6, 2007 :: Article - 1 page
(free registration or data entry required)

A grocery store chain based in Maine declared success yesterday for a year-old experiment in using a rating system to direct customers to healthier food items.... ....The system that Hannaford developed, called Guiding Stars, rated the nutritional value of the grocery items in the store on a scale of zero to three stars, with three representing the most nutritious products.... ....A survey of Hannaford customers found that 81 percent were aware of the Guiding Stars program, and half of them said they used it “fairly often.”

Hannaford health innovator Peter Hayes is a Center Director.

Click for the Washington Post's article on the Guiding Stars program

C.M.U Researchers Say Higher Drug Co-Pays Don't Save Employers as Much as They Think
Pittsburgh Post-Gazette :: August 22, 2007 :: Article - 1 page
(immediate access)

When a company raises employees' prescription drug co-payments, it will not realize the savings it expects, according to a study on health care costs at Carnegie Mellon University. "What most employers don't consider is that increased co-pays on drugs may lead to an increase in other types of health care," said William B. Vogt, associate professor of economics and public policy at Carnegie Mellon. "Not all savings are really savings. They are offset by other types of spending."

Looking Past Blood Sugar To Survive With Diabetes
New York Times :: August 19, 2007 :: Article - 4 pages
(free registration or data entry required)

Nearly 73,000 Americans die from diabetes annually, more than from any disease except heart disease, cancer, stroke and pulmonary disease. Yet, largely because of a misunderstanding of the proper treatment, most patients are not doing even close to what they should to protect themselves. In fact, according to the federal Centers for Disease Control and Prevention, just 7 percent are getting all the treatments they need.... ....A quarter to a third of all heart attack patients have diabetes, even though diabetes patients constitute just 9.3 percent of the population. Another 25 percent of heart attack patients are verging on diabetes with abnormally high blood sugar levels.... ....[Dr. Irl B. Hirsch, a professor of medicine and director of the diabetes clinic at the University of Washington] has a message for diabetes patients: If he had to rate the different regimens for a typical middle-age person with Type 2 diabetes, the first priority would be to take a statin and lower the LDL cholesterol level.

Prescription Noncompliance Remains A Sticky Problem
Employee Benefit News :: August 2, 2007 :: Article - 1 page
(immediate access)

Only about 50% of patients typically take their medicines as prescribed, the World Health Organization estimates. In the U.S., non-adherence affects patients of all ages and genders and is just as likely to involve higher-income, well-educated people as those at lower socioeconomic levels.

Fighting Cholesterol Starts With A Test
Wall Street Journal :: August 1, 2007 :: Column - 1 page
(paid subscription required)

....Choosing a cholesterol drug boils down to three questions: Will it get the cholesterol low enough, will the patient tolerate it and can the patient afford it?... Most patients have good intentions of managing their health without medication, but can't sustain the improvements long term.... ....Sometimes insurers push generics so much that we sacrifice some control of cholesterol with more potent brand-name drugs to find a medication the patient can afford.... Finding the right medication or combination of medications is half the battle. Keeping the patients on the medication long enough to do them any good is the other half. Many patients stop their cholesterol meds within the first six months.

Sending Back The Doctor’s Bill
New York Times :: July 29, 2007 :: Commentary - 1 page
(immediate access)

....many health care economists say both sides are wrong. These economists, some of whom are also doctors, say the partisan fight over insurers and drug makers is a distraction from a bigger problem: the relatively high salaries paid to American doctors, and even more importantly, the way they are compensated.....“The whole health-care system is set up to pay for services that are rendered,” [Rand's Dr. Dana Goldman] said, “when the patient, and society, is interested in health.”

PA. Law Expands Job Scope Of Nurses
Philadelphia Inquirer :: Harrisburg, Pennsylvania :: July 20, 2007 :: Article - 1 page
(immediate access)

A new law intended to reduce health-care costs and increase access to treatment by giving nurses and other medical assistants greater latitude is expected to be signed by Gov. Rendell today....Giving nurses more responsibility, Greco said, translates into quicker care for patients, especially for chronic diseases such as diabetes. In the past, those patients had to wait for treatment from a physician when a nurse could have acted just as easily.

MO Company Helps Start Medical Clinics
Forbes, originated by Associated Press :: Kansas City, Missouri :: June 28, 2007 :: AP Article - 1 page
(immediate access)

more than a year after opening its high-tech, paperless clinic, North Kansas City-based Cerner (nasdaq: CERN - news - people ) has decided to branch out from its medical software business and set up similar clinics at other companies....

Health Expert Warns Of Approaching Crisis
Minneapolis Star-Tribune :: Minneapolis, Minnesota :: June 19, 2007 :: Article - 1 page
(immediate access)

Health care in the United States is at a critical crossroads as an aging population, with its looming set of costly chronic conditions, threatens to increase financial pressure on an already strained system, one of the country's top health care experts warned Tuesday. Leonard Schaeffer, former chairman and chief executive of WellPoint Inc., the nation's largest insurer, said that as the baby boom generation reaches Medicare age, the government's ability to pay for coverage will be sorely tested....

Background: Leonard, Schaeffer

Study Finds Staggering Cost Of Treating Diabetics
Yahoo! News, originated by Reuters :: New York, New York :: June 19, 2007 :: Article - 1 page
(immediate access)

One out of every eight U.S. federal health care dollars is spent treating people with diabetes, a study found, and advocates are calling for the creation of a government post to oversee coordination of spending on treatment and prevention among federal agencies.... ....The National Changing Diabetes Program (NCDP) study was being released at a briefing with the Congressional Diabetes Caucus on Tuesday....NCDP...is funded by Denmark's Novo Nordisk, one of world's largest sellers of insulin and diabetes products.

More Green For Blues
Chicago Sun-Times :: June 15, 2007 :: Article - 1 page
(immediate access)

As the line continues to blur between the insurance and financial-services industries, the Chicago-based Blue Cross and Blue Shield Association has eased into the thrift business.... ....The association and 32 of its 39 affiliates are shareholders in the Blue Healthcare Bank, a federal savings bank chartered in Utah with the hopes of capturing some of the growing market for health savings accounts, health reimbursement accounts and flexible spending accounts.

Double-Digit Health Care Cost Increases Forecast
Society For Human Resource Management :: June 14, 2007 :: Article - 1 page
(immediate access)

The cost of providing health care is expected to increase as much as 11.2 percent in the next 12 months, according to a recent survey of more than 70 health insurers representing more than 100 million insured individuals.... ....“Although it is encouraging to see a continuing decline in health care trend rates, employers are still challenged by the fact that health care cost increases are more than four times general inflation rates,” said Bill Sharon, senor vice president with Aon Consulting and director of the study.

In Health Care, Cost Isn’t Proof Of High Quality
New York Times :: June 14, 2007 :: Article - 1 page
(free registration or data entry required)

In a Pennsylvania government survey of the state’s 60 hospitals that perform heart bypass surgery, the best-paid hospital received nearly $100,000, on average, for the operation while the least-paid got less than $20,000. At both, patients had comparable lengths of stay and death rates. ....the Pennsylvania findings support a growing national consensus that as consumers, insurers and employers pay more for care, they are not necessarily getting better care. Expensive medicine may, in fact, be poor medicine.

Why Progress Toward Electronic Health Records Is Worse Than You Think
Information Week :: May 27, 2007 :: Article - 5 pages
(immediate access)

....Santa Barbara serves as a reality check on the U.S. health care system's slow progress toward a real EMR network. The diagnosis: It's worse than you think.... ....Just 10% of doctors' offices use them. And while hospitals are expanding their use, the most difficult work--the exchange of data among health care providers, especially with rivals--has barely begun..... ....failures like Santa Barbara's make it harder to build the trust and financial support needed to make regional data sharing work.... ....Companies want more progress because they're feeling the pain of rising health care costs for employees, and they believe in IT's role in lowering that--just as they've applied tech to improve processes at their own companies.....

Employee Personal Health Records Pressure Doctors To Go Digital

Health Savings Plans Start To Falter
Wall Street Journal :: June 12, 2007 :: Article - 1 page
(paid subscription required)

President Bush and many big employers have hailed "consumer-directed" health plans and savings accounts as an effective weapon in the battle against runaway medical costs. But several years after the plans got off to a fast start, the approach appears to be stumbling -- largely because of consumers' unease in using them.... ..."If you're just trying to cost shift, and you only get 10% of your employees in, they are the youngest and healthiest, and you haven't accomplished anything in terms of health-care costs," says Bill Sharon, a senior vice president at Aon Consulting, the human-resources consulting arm of insurance broker Aon Corp.

Pinning Down The Money Value Of A Person’s Life
New York Times :: June 11, 2007 :: Article - 2 pages
(free registration or data entry required)

....Economists are sometimes accused of knowing the prices of everything and the value of nothing. Now they are trying to answer what may be the most difficult question of all — the price of health....

Who Pays For Efficiency?
New York Times :: June 11, 2007 :: Article - 2 pages
(free registration or data entry required)

....the quest to save dollars in the nation’s $2.1 trillion annual health care bill is becoming a lucrative market of its own. Thousands of companies, large and small, are pitching cost-saving ideas that range from electronic patient records to new medical devices.... ....In the nation’s fee-for-service system of medical payments, the more procedures that are done, the more money a specialist or a hospital receives.... ...Health care reformers say that treatments are justified when there is evidence of sound science and financial logic. That threshold, it seems, is not the standard today....

a 2-page piece on wringing economies from the US health care system, and no mention of employer involvement - remarkable.

Health Costs Push Companies To Set Targets For Workers
New York Times :: June 11, 2007 :: Article - 2 pages
(free registration or data entry required)

As the nation’s employers aim to get their money’s worth from ever more expensive medical insurance, many are playing a bigger role in managing and monitoring their workers’ health.... ....Intuit pays employees $100 each for voluntarily filling out an online medical questionnaire that is intended to flag problems and suggest remedies.... ....The system will initially focus on employees with chronic illnesses, with the first report card geared to people who have Type 2 diabetes.... ...“Employers are realizing that a good health care strategy includes health benefits and programs that incentivize employees to manage their own health,” Larry Boress, chief executive of the Midwest Business Group on Health, the nonprofit group that conducted the survey, said in a news release.... ....Carlson Companies, a Minneapolis holding company whose businesses include the Radisson hotel chain, plans to begin such a program in July, offering some employees the chance to win cash or merchandise for participating.

Injecting Health Care Into The Workplace
Risk & Insurance :: June 10, 2007 :: Article - 1 page
(immediate access)

With an eye toward the bottom line, many companies are choosing to limit and even reduce health-care costs by opening on-site wellness clinics for their workers. The convenience, increased productivity and proactive health-care approach are only a few of the added benefits of such a move.... ....convenience is only part of the attraction. On-site clinics present a viable solution to increasing health-care costs....

Call The Doctor
New York Times :: June 10, 2007 :: Column - 1 page
(immediate access)

When the news broke last month that significant questions had been raised about an increase in the risk of a heart attack for users of Avandia, I followed the reports with a bit more avidity than most.... ....The headline takeaway last month was that a published study by Dr. Steven Nissen, a noted cardiologist and the man who first alerted the public to the dangers of Vioxx, found that Avandia actually increased heart attack risk by 43 percent and sported a 64 percent increase in the risk of death from cardiovascular causes.... ....because the Avandia controversy manages to unite three sectors not held in the highest public esteem — Big Pharma, Big Media and Big Government (the lawyers will be along any minute) — it has led to a lot of hyperbole online. And as Michael Moore is about to demonstrate with his new movie, “Sicko,” people are often willing to believe the worst about the health care industry and they are rarely disappointed..... ....The controversy is turning into something of a throwdown between cardiologists, who look after the heart, and endocrinologists, who want to use every safe and effective drug in the tool belt to get blood sugars down..... ....after some time spent researching the whole issue, I decided to just back away from the mouse. Data is not knowledge, and information is not insight; consumers still have to make their own judgments about the agendas that are at work.....

The article contains links to several interesting blogs on diabetes and the pharmaceutical industry.

Pay Shows Scant Effect On Medical Treatment
Wall Street Journal :: June 6, 2007 :: Article - 1 page
(paid subscription required)

A central premise of the government's Medicare planners in recent years has been a concept called "pay for performance" -- the idea that medical care can be improved by financially rewarding better treatment. But the results of a Medicare-agency pilot project, published this week, suggest the efforts may be less effective than proponents hope.... ....It's possible the financial penalties for not complying weren't sufficient. "Those with the poorest performance risked future financial penalty," researchers said, but didn't actually pay such a penalty. Bonuses for complying with performance standards totaled $17.6 million to a total of 123 hospitals in the first year and 115 hospitals in the second year.

carrots are better than sticks, but the math suggests the carrots employed in the study were on the scrawny side....

6 Billion Bits Of Data About ME, ME, Me!
New York Times :: June 3, 2007 :: Article - 1 page
(free registration or data entry required)

Soon enough, scientists say, we will all be able to decipher our own genomes — the six billion letters of genetic code containing the complete inventory of the traits we inherited from our parents — for as little as $1,000. Just what we will do with the essence of who we are once we bottle it, however, is likely to be as much a social experiment as a scientific one.... ....The more genomes that scientists have to work with, the more they can learn about them. So staying on top of your own health outlook may begin to resemble checking the performance of your stock portfolio. One day you find you have a gene that puts you at risk for diabetes; the next it’s one that may make you live longer.... ....the early boosters of the personal genome say the best bet for improving individual health care is not only to embrace genetic knowledge about ourselves, but to share it with others. If hundreds of thousands of people make their genomes public — along with personal information about their ancestry, their health history, what they look like, what they do and where they live — they argue, scientists will finally be able to draw meaningful correlations between variations in DNA sequence and any trait that has even a partial genetic basis, from what drugs we should take to what foods we like to eat.

Want Treatment With Those Pills?
Newsweek :: June 25, 2006 :: Article - 1 page
(immediate access)

Walk-in clinics are springing up in retail chains nationwide, offering shorter wait times, lower prices—and a challenge for doctors. More than 100 walk-in clinics—with names like RediClinic, MinuteClinic, and Take Care Health—are already operating in major retail stores like Wal-Mart, CVS and Rite-Aid.... ....Richard Scott, chairman of the Florida-based Solantic, which operates a dozen clinics in Florida and plans to open as many as 1,000 locations across the country over the next five years, notes that there are more than 40 million uninsured Americans—and millions more who can't get a timely appointment to see their primary care provider, don't have a provider, or don't want to spend the money or time to go to the emergency room.

Diabetes Drug Costs Could Soar 70 Pct By '09-Report
Reuters :: May 17, 2007 :: Article - 2 pages
(immediate access)

A growing diabetes epidemic and more aggressive treatment with combination drug therapies could result in a rise of nearly 70 percent in drug spending on the disease through 2009, according to a report released on Thursday by Medco Health Solutions Inc. Medco's 2007 Drug Trend Report found diabetes treatments trailing only cholesterol medications in total prescription drug spending growth in 2006.... A wave of new diabetes treatments, such as Merck & Co.'s Januvia, and Byetta from Eli Lilly and Co. and Amylin Pharmaceuticals Inc. and others expected to hit the market from the likes of Novartis and Novo Nordisk will help push up treatment costs, the [Medco] report said.... ...."While prevention of type 2 diabetes needs to be a national priority, drug treatments can help prevent the onset of complications from diabetes that lead to hospitalizations, more complex treatment and dramatically higher costs," [Medco CMO Robert] Epstein said. "For those patients who depend on medications to avoid serious complications, compliance is paramount." Health plan initiatives to encourage more preventive care can also curb spending growth, the report said.

Dental Plans Offer Rollovers: Trend Lets Patients Build Allowances With Regular Care
Wall Street Journal :: May 23, 2007 :: Article - 1 page
(paid subscription required)

A growing number of group dental plans are letting patients roll over their unused maximum treatment limits to following years, similar to unused cellphone minutes. But often members must visit the dentist annually or more often for preventive care to get the extra allowance. The trend started recently with Ameritas Life Insurance Corp. and Guardian Life Insurance Co. of America, companies that primarily serve small and medium-size employers in group dental plans.... ...Insurers say the feature makes dental plans more attractive to employers and consumers at a time when they're under pressure from rising medical costs. Even though dental premiums rose just 2.7% last year, compared with 7.7% for medical plans, according to the National Association of Dental Plans, many employers have been increasing worker contributions. More employers also are offering so-called voluntary dental plans, under which employees must pay the premiums themselves. The rollover feature also helps employers and insurers by encouraging low-risk patients not to drop their dental coverage, which would leave behind only members in poor oral health, driving up costs for everyone in the plan.

Google Helps Start-Up Search Out Free Electronic Health Record System
CMP Medica :: April 19, 2007 :: Article - 1 page
(immediate access)

A start-up vendor has teamed with web search giant Google to offer a free electronic health record system to physicians. The service, now in beta version from Practice Fusion, is believed to be the first on-demand medical records product available to physicians at no cost.... ....The EHR service is separate from Google, which merely drives the application. Google will not handle any of the patient data passing through it. Data will reside in a central repository owned and controlled by Practice Fusion... ....The service incorporates a security model compliant with Health Insurance Portability and Accountability Act and HL7 directives, Howard said. It also includes an integration layer that will enable it to access and share records with other systems....

An 'ad-free' PracticeFusion subscription is $3,500 per seat - yea, I suppose a couple of little tiny text ads in the margins aren't soooo bad....

Diabetes Drug Called Potential Death Risk
USA Today :: May 22, 2007 :: Article - 1 page
(immediate access)

Nine months ago, the drug company Glaxo-SmithKline posted a study along with dozens of others on an obscure company website. The study indicated that the company's blockbuster diabetes drug, Avandia, raised patients' heart disease risk by 30%. At about the same time, company officials say, they told the Food and Drug Administration what they had found. That apparently wasn't the first time Glaxo warned the agency about its drug. FDA's Susan Cruzan confirmed Monday that the company had warned the agency of a potential safety problem at least as early as 2005. Yet neither the company nor the FDA took additional steps to warn the public until Monday, when a fast-tracked study released on the Internet by a major medical journal prompted the agency to issue a Safety Alert warning of a "potentially significant" excess risk of heart attack and heart-related deaths....

Michael Moore Hopes ' Sicko' Disgusts You
Los Angeles Times :: Los Angeles, California :: May 22, 2007 :: Article - 1 page
(immediate access)

Michael Moore and his movies have always been hard to miss. But with "Sicko," his acidic new documentary about healthcare, there's suddenly less of the filmmaker and his usual methods.... ....The famously outsized filmmaker, having spent several years studying healthcare, even has lost 25 pounds — "One way to fight the system," he says, "is to take better care of yourself." But what's most striking about "Sicko" is that Moore's current target is much harder to pinpoint. Whereas the foils of his earlier films were obvious — General Motors in "Roger & Me," the gun industry in "Bowling for Columbine," the Bush administration in "Fahrenheit 9/11" — the ultimate protagonist in "Sicko," opening June 29, is American indifference.

Take Your Medicine: Strategies For Sticking To A Drug Regimen
Wall Street Journal :: May 22, 2007 :: Article - 1 page
(paid subscription required)

....One of the most vexing problems in health care today is the fact that as many as 50% of patients don't take their medicine on a regular basis or at all. The reasons are complex. Patients with high blood pressure, high cholesterol or osteoporosis often forget to take their drugs because they don't have obvious symptoms to remind them. Other patients stop taking pills when they start to feel better -- as is common with antibiotics.... ....Getting patients to take their medicine has a big impact on the health-care industry. When patients take their pills, drug companies earn more, insurance companies lower costs and patients are healthier. A study in Asheville, N.C., paid pharmacists to counsel patients and make sure they were taking their medication. City workers were offered financial incentives to take part in the program. After one year, the workers' average blood-sugar levels had dropped 6%, the city was saving an average of $500 per patient in health-care costs, and the workers took an average of 6.5 fewer sick days than similar workers not in the program.

Employers Cut Drug Copays To Save Money
Wall Street Journal - Health Blog :: May 8, 2007 :: Blog post - 1 page
(paid subscription required)

To save money on health care, some companies and insurers are now picking up a bigger share of patients’ tabs for some prescription drugs. There’s a method to the apparent madness, which runs counter to the prevailing trend of pushing more of the cost of care onto consumers. Chronically ill patients who take their medicines need less care (and less-expensive care) in the long run. And a good way to get patients to stick to their drug regimen is to make it cheaper for them to get drugs, Vanessa Fuhrmans writes in this morning’s WSJ. A few examples: * Marriott cut copays for drugs for heart disease, diabetes and asthma. * University of Michigan cut copays for diabetes patients. * Pitney Bowes gives patients drugs for diabetes and asthma, and has reduced copays for other drugs. * UnitedHealth cut copays for a chloroflurocarbon-free asthma inhaler.



Link to WSJ's "New Tack on Copays: Cutting Them"

From Clipboards To Keyboards
The Economist :: New York, New York :: May 17, 2007 :: AP Article - 1 page
(immediate access)

The financial-services industry spends about $200 billion a year on high-tech kit; health providers spend just over a tenth of that amount.... ....Steven Van Kuiken of McKinsey, a consultancy, argues that the main obstacle to EMRs is the misalignment of costs and benefits among different groups. Although large hospitals, insurers and vendors would reap big gains from computerisation with quite small investments, he notes, small surgeries with just a few doctors face enormous headaches in converting from clipboards to keyboards.... ....Employers are also keen on technology, since it promises to curb health-care costs and improve efficiency. Intel, BP, Wal-Mart and several other big companies got together last year to form Dossia, an independent, non-profit company that will develop an EMR system to give employees lifelong, portable medical histories. And over a hundred other firms including Dell, IBM and Microsoft now allow employees to manage their health affairs via WebMD, a big health-information website....

CalPERS To Charge More For Doctor's Visits In Bid To Stem Costs
The Ledger, originated by Associated Press :: Sacramento, California :: May 17, 2007 :: AP Article - 1 page
(immediate access)

The board of the nation's largest public pension fund voted Wednesday to ask members to pay slightly more to see the doctor, as part of a plan they hope will restrain escalating premium costs. Doctor copays will be waived for preventive care, such as routine checkups, baby and maternity care.

Employers Plan Health Incentives For Workers
Chicago Tribune :: Chicago, Illinois :: May 17, 2007 :: Article - 1 page
(free registration or data entry required)

Three in five employers plan to provide cash and other incentives to motivate their workers to use preventive medical-care services to curb illness, according to a new study by the Midwest Business Group on Health.

In Bid For Better Care, Surgery With A Warranty
New York Times :: May 17, 2007 :: Article - 2 pages
(free registration or data entry required)

What if medical care came with a 90-day warranty?... ....Since Geisinger began its experiment in February 2006, focusing on elective heart bypass surgery, it says patients have been less likely to return to intensive care, have spent fewer days in the hospital and are more likely to return directly to their own homes instead of a nursing home. Geisinger presented the first-year results of its experimental program at a meeting last month of the American Surgical Association.

Sometimes, Sightseeing Is A Look At Your X-Rays
New York Times :: May 16, 2007 :: Article - 1 page
(free registration or data entry required)

....For decades, Americans have known they could obtain cheaper health care abroad, and have slipped off to Mexico for small surgeries or Canada for prescription drugs. But more and more people now recognize foreign hospitals can deliver not only cheap but also high-quality health care, and are considering medical tourism even for serious health problems.... Now, the United States health establishment may be coming to the same realization I did. To be sure, insurers’ worries about quality control and liability risk at foreign hospitals may still keep them from embracing medical tourism. But with spending on health care in America topping $2 trillion, baby boomers aging and the pool of uninsured rising above 43 million, insurers, smaller employers and individual Americans without insurance are looking at overseas care as an alternative for costly treatments, even for complex procedures like heart surgery and procedures excluded from coverage in the United States.... ...Several insurers have proven to be medical tourism pioneers. United Group Programs, a Florida insurance company, now offers plans that reimburse types of overseas care, and works with Apollo, a leading hospital in Chennai, India. Health Net, another insurer, now offers subscribers in Southern California some coverage at medical facilities across the border in Mexico. ....Already, the press in Thailand and India has warned that medical tourism, which can be more lucrative for physicians, is sucking doctors away from public clinics.

Handling House Calls In A Managed-Care World
New York Times :: Seattle, Washington :: May 16, 2007 :: Article - 2 pages
(free registration or data entry required)

....Care Level Management, a company based in Woodland Hills, Calif., that employs about 100 doctors in five states, offers medical service to 13,500 chronically ill patients. It pairs each patient with a doctor who provides a cellphone number and urges the patient to call for a home checkup at the first sign of trouble. Medicare and private insurers pick up Care Level’s bill (the patient is usually charged a co-payment as well). Care Level takes on the 2 percent to 5 percent of the insurers’ patients who have amassed the highest medical bills. Its average patient is 76, battling 11 chronic conditions like diabetes, hypertension and congestive heart failure, and has been hospitalized often. Care Level says that its house calls save insurers money by drastically reducing emergency room visits and hospitalizations. In fact, it guarantees savings.

Oregon's Wyden Leads The Way On Health-Care Reform
The Seattle Times :: Seattle, Washington :: May 15, 2007 :: Syndicated column - 1 page
(immediate access)

Oregon Sen. Ron Wyden doesn't want to wait until 2008. The Democrat's Healthy Americans Act is the first serious proposal for universal coverage in 13 years. Some business leaders and unions have blessed it, as has influential Republican Sen. Bob Bennett of Utah.... ....The proposal's greatest triumph would be ending our reliance on employment-based coverage. Corporate health benefits, which are tax-free for workers and deductible for employers, favor the wealthiest and trap many Americans in jobs they'd love to leave.

The columnist is with the Providence, RI-based Providence Journal.

Are Employers The Future Leaders In Chronic Care Management?
Digital Healthcare & Productivity :: May 15, 2007 :: Article - 1 page
(immediate access)

Senior director of benefits, Delia Vetter explained that their Healthlink portal has seen significant participation. For example, approximately 90% of employees have taken an online health risk assessment (if they don’t, they see a 12% increase in premium contribution). All claims are imported from a data warehouse into a personal health record (PHR), giving employees and families a three year history of office visits, medications and conditions....EMC is moving to more aggressive management of its chronically ill employees. It’s been successful in a diet program to reduce hypertension costs — claiming up to a $1,000 per capita saving for patients with multiple co-morbidities.

Humana Offers Lower Costs For Healthier Workers
American Medical News :: May 14, 2007 :: Article - 1 page
(immediate access)

Humana says it is offering a money-back guarantee on plans it manages for large, self-insured employers. The Louisville, Ky.-based health plan says it will guarantee that those employers' health care claims costs will increase by no more than 6% to 9% a year, depending on the specific plan, over the next three years, or Humana will refund up to 40% of the fee it charges to administer benefits....Humana says it will keep those claims costs down by instituting wellness programs for its client companies' employees....SmartResults [is] available to self-funded businesses with 300 or more employees

Retail Health Clinics Working For Sutter; More Locations Planned
Sacramento Business Journal :: Sacramento, California :: May 14, 2007 :: Article - 1 page
(immediate access)

Five months after Sutter Health's foray into the retail health business kicked off in a Natomas Rite Aid drugstore, almost 3,300 patients have been treated at the medical system's six clinics in the region. Seventeen healthcare providers now staff that clinic and those in Gold River, Elk Grove, Greenhaven, Folsom and, as of April 26, Roseville. ...Two-thirds of the patients are aged 19 to 64. Most of the rest are under 19. Demand is highest on weekends, in the late morning and at lunchtime on Saturdays and Sundays.... ...Less than 10 percent, fewer than expected, have come in for routine screenings and physicals. [QuickHealth CEO David Mandelkern] is not surprised by the low demand for screenings. "It's difficult to get people to pay for preventive care. They come in when they are sick," he said.

view information for Sutter Health

interesting window on convenient care demand in CA - currently relatively little during weekdays, though almost all users are either of working age or children. The piece also references Wellness Express's closure: "WellnessExpress, opened a clinic in Longs Drugs in Davis in April 2005, but the San Ramon-based company ran out of money and closed it Nov. 17." Also interesting is Mandelkern's comment on the underutilization of preventive care - a golden opportunity for employer engagement.

Project Melds Health-Care, Banking Info: Backers Say Idea Could Slash Costs Of Medical Care
The Daily Tennessean :: Memphis, Tennessee :: May 9, 2007 :: Article - 1 page
(immediate access)

....Later this year, the project plans to launch a computer-based platform called BoardTrust that would let banks share information, including medical records, and provide standards to govern that process. Executive Director John Casillas thinks banks could cut health-care costs and that they could certainly help trim the $35 billion a year spent to process medical bill payments.....

New Tack On Copays: Cutting Them
Wall Street Journal :: May 8, 2007 :: Article - 1 page
(paid subscription required)

Employers, Insurers Bet That Covering More Of The Cost Of Drugs Can Save Money Over The Long Term For Chronic Conditions - Desperate for ways to curb soaring health-care costs, a groundswell of employers and health insurers are turning to a radically different approach: motivate patients to take not just the cheapest medicines, but the ones they need the most.... Employers such as Marriott International Inc., Procter & Gamble Co. and Eastman Chemical Co. have now reduced or eliminated copayments for drugs for certain chronic conditions, such as heart disease. Pitney Bowes Inc., which already gives away diabetes and asthma drugs, has lowered copays this year for osteoporosis treatments, anti-seizure medications and prenatal supplements. For diabetics and heart-attack patients, it has made cholesterol-lowering statins free. And at least one major insurer, Aetna Inc., is studying whether to implement the approach with certain drugs and patients across its health plans.

Background: Andrew Scibelli, Florida Power & Light

Center advisors' innovations are referenced throughout this concise piece, available to online Journal subscribers.