Steve Jobs famously staked his claim at the intersection of technology and creativity. Health insurers are looking for the intersection of technology and benefits knowledge, but are not quite sure how to get there. Do you hire information technicians and train them in the ways of health coverage, or do you hire (or promote from within) people who know insurance and train them to be IT savvy?
Forty-four thousand dollars is certainly a meaningful amount of money to me, but apparently not so meaningful as to encourage a sizeable portion of physicians to adopt meaningful use standards for electronic health records.
“As of May 2012, a total of 62,226 eligible professionals had attested to meaningful use under the Medicare program,” according to a letter in the February 21 edition of the New England Journal of Medicine. “This represents 12.2 percent of the estimated 509,328 eligible physicians in the United States, including 9.8 percent of specialists and 17.8 percent of primary care providers.”
So while the growth in the number of participating doctors might seem dramatic at first glance (see our chart from the January issue of Managed Care), the actual numbers are underwhelming, according to the letter written by Adam Wright, PhD, of Brigham and Women’s Hospital. (Reach him at firstname.lastname@example.org.)
In April of last year, I wrote about the first release of recommendations from the American Board on Internal Medicine Foundation in conjunction with nine medical societies as part of a campaign: Choosing Wisely. The campaign aims to draw attention to and call into question commonly ordered tests like chest x-rays before surgery, frequently performed procedures like colonoscopies, and frequently prescribed treatments like antibiotics for upper respiratory infections.
Stories about underdogs (David and Goliath, Rocky, the 1969 Mets, the 2008 Barack Obama) are as much about overconfidence as they are about confidence. Yes, the challenger is scrappy. The favorite, on the other hand, needs just enough hubris to make his or her downfall ensure that the lesson resonates with every would-be David and Goliath — and in its entirety because we all have a little of each in us.
Amgen is making a huge bet on biosimilars and helping to define the market.
The company announced that it is targeting 6 biotech blockbusters and will start selling them as biosimilars in 2017. The initial targets: Avastin, Herceptin, Rituxan, Erbitux, Humira and Remicade. That’s over $40 billion in product. Even a small savings, like 15% to 20%, would result in a huge change in premiums.
It is still unclear what hurdles will need to be cleared from the FDA and/or other regulatory bodies, but a few other things have become very clear:
The Department of Labor has issued new guidelines concerning the wellness provisions of the Affordable Care Act (ACA) that relate to the use of financial incentives, and the Office of Health Plan Standards and Compliance Assistance is seeking public comment. This document proposes “amendments to regulations, consistent with the Affordable Care Act, regarding nondiscriminatory wellness programs in group health coverage." These regulations increase rewards for wellness participation or outcomes from 20 to 30% or up to 50% related to reducing tobacco use.
Researchers in Britain recently published a paper in Pediatrics showing a dramatic swing in admissions for childhood asthma after indoor smoking was banned by the British in 2007. A hospitalization trend that had been steadily around 2% fell to minus 9%. The trend was sustained. 10.1542/peds.2012-2592
With apologies to James Taylor, I was recently introduced to a UNC-Chapel Hill professor of psychology, Dr. Edwin Fisher, from my alma mater and the university where the famous singer/ songwriter's father was dean of the School of Medicine. The work that Dr. Fisher is doing under the aegis of the American Academy of Family Physicians Foundation is on target for the Triple Aim.
Peers for Progress, designs, implements, and evaluates peer coach or peer educator programs worldwide. There are ample examples of successful and established programs led or facilitated by peer coaches, motivators, educators, or others, including Alcoholics Anonymous, Mended Hearts, and Weight Watchers. Peers for Progress is building a global network of peer-support organizations that are making a difference in the health of and lives of people affected by a range of health problems and their associated impact on the individual and on communities.
It’s hard to open any health-related publication these days and not find stories about accountable care organizations (ACOs). Commentary ranges from extolling ACOs as our last, best hope for achieving high-value care in the U.S., to others criticizing ACOs as a thinly disguised return to the 1990s model of managed care and HMOs.
While it’s too early to judge how effectively these provider-based organizations that assume greater financial risk for health care outcomes will ultimately perform, many are hopeful that ACOs offer a promising vehicle for achieving the elusive Triple Aim goal of health reform — achieving higher clinical quality and better experience of care with lower cost trends.
Though the title might apply to many aspects of our daily lives and the world as a whole, in this instance I am referring to how Medicare and other insurers interpret the word reasonable to make coverage and payment decisions. A recent editorial in the New England Journal of Medicine highlighted this enduring challenge for Medicare.
The authors begin with language from the Social Security Act: