Tuesday Tidbits

The Wall Street Journal had an interesting section yesterday about healthcare innovations. The lead article discussed how the medical profession is incorporating the quality of life improvement goals into treatment plans in order to encourage patient compliance.

The logic is simple. People are more likely to manage their condition properly when they have more accessible, personal goals, like being able to do more at work or keep up with their kids, instead of focusing only on comparatively abstract targets like blood-sugar levels. And that, in turn, leads to much better health.

The article explains that

The 2010 Affordable Care Act included $3 billion in funding for a new Patient-Centered Outcomes Research Institute, which will use quality-of-life measures as part of its evaluation of new treatments. And in a report issued in January, the Institute of Medicine, an independent group that advises the government on health policy, called for a new national action plan to identify programs that help those with chronic illness and the population as a whole "live well"—reflecting "the best achievable state of health that encompasses all dimensions of physical, mental and social well-being."

The AMA News reports on the ABIM Foundation's  Choosing Wisely campaign which encourages doctor and patients to make health care decisions based on medical evidence based recommendations. The program is endorsed my the AMA and many other medical associations. Here is a link to the program's lists of specific, evidence-based recommendations physicians and patients should discuss when the following types of health issues arise:

• When do you need an EKG or stress test for heart disease? (American Academy of Family Physicians)
• When do you need an imaging test for a headache? (American College of Radiology)
• When do you need antibiotics for sinusitis? (American Academy of Asthma, Allergy and Immunology)
• When do you need antibiotics for sinusitis? (American Academy of Family Physicians)

According to the program's website, "several more specialty societies have joined the campaign and will be unveiling their lists of "Five Things Physicians and Patients Should Question" in fall 2012." Now that's a program that could bend the cost curve down.


The AP via Businessweek reports that prescription benefits manager Express Scripts has issued its annual Drug Trend Report. Express Scripts announced that "spending increased 2.7 percent in 2011, the lowest growth recorded in 18 years of measuring the statistic" due to the introduction of generic substitutes for blockbuster drugs like Lipitor. The FEHBlog found very interesting the fact that "diabetes treatments now make up the largest spending category for prescription drugs [according to Express Scripts]. Diabetes spending per member per year rose 7 percent to top cholesterol and high blood pressure or heart disease medicines."

To tie this all together, the Wall Street Journal's innovation section also discussed a United Healthcare lifestyle program which uses YMCAs to help control diabetes costs for health plans. "The YMCA gets reimbursed by insurance companies and employers for people who enroll in the yearlong diabetes-prevention course. If class enrollment goals are reached, and if participants lose 5% to 7% of their body weight over the year, the Y gets additional payments." The FEHBlog first heard about this innovative program at the OPM AHIP FEHBP carrier conference last month.