2012 Potpourri XXVI

A study in Health Affairs discusses what it may take to achieve savings in a Medicare coordinated care program.  The program was at the Washington University School of Medicine and was not initially successful in reducing costs or utilization.  The school redesigned the program to stop using remote phone interventions and instead use a combination of in-person and occasional phone contacts from a local care manager.  The number of patients focused on was reduced and stronger transition planning and medication reconciliation was introduced.  These changes led to a 12% reduction in hospitalizations and a $217 per person per month reduction in spending, more than the program’s cost.   (HA Article)

Consultant and data provider Mark Farrah released information on Q1 results for health plans.  Most plans had enrollment gains, but a slight decrease in profitability.  On a year-over-year basis, the seven leading health insurers increased membership by 3.5 million to 130.8 million.  Most of the commercial growth was in self-insured accounts.  WellPoint and Aetna lost members in the first quarter, but the remainder of the top seven had gains, with UnitedHealth and Cigna leading the way.  UnitedHealth also had a profit increase while the remainder of the top seven plans experienced a decrease.  Medicaid and Medicare lines also increased membership for most of the plans.   (Farrah Report)

Hospital at home is an intriguing concept discussed in another Health Affairs article.  Generally patients are admitted to hospitals for acute care, but hospitals can sometimes create health problems through errors, infections and other problems.  A new model is to provide acute care in the patient’s home when possible.  The article describes a program at a New Mexico hospital which savings of 19% for Medicare Advantage and Medicaid patients compared to similar patients who were hospitalized.  These patients also had as good or better clinical outcomes.  Patients also were more satisfied with the program than usual care.    (HA Article)

A Mercer survey of 1200 employers regarding health reform finds that 60% expect cost increases to result from the law, with 20% saying it will be 5% or more.  Employers with large part-time employee populations and employers in the health care sectors expect the highest increases.  Some employers may take action to keep employees under the 30 hour requirement where coverage is required to be provided.  About 6% of employers said they intend to drop coverage by 2014.  In general, employers appear to be behind on some of the planning and implementation required by the law.   (Mercer Survey)

Healthways released a study regarding the effect of good health habits on employee productivity.  The survey of about 20,000 employees at three large companies indicated that having unhealthy behaviors is related to productivity loss.  Poor diet was associated with a 66% greater likelihood of lower productivity, getting little exercise with a 50% higher likelihood and smoking with a 28% higher one.  If the behaviors were specifically related to the work environment, the productivity loss was higher, for example, not being able to exercise during the day led to a 96% greater likelihood of lower productivity.  Women, those aged 30-39, those separated, divorced or widowed and clerical and office workers had the greatest rates of productivity loss.    (Healthways Release)

End-of-life care is responsible for a lot of health care spending and spending growth.  Many times episodes at the end-of-life begin in the emergency room.  A Health Affairs article describes these episodes.  The study looked at the experience of about 4600 Medicare recipients who died between 1992 and 2006.  This cohort had a much higher rate of ER use than did a matched set that did not die, with 51% going to an ER within the last month before death and 75% in the last 6 months. Of the patients seen in the last month of life, 77% were admitted to a hospital and 68% of these patients died in the hospital.  In comparison, people in a hospice setting rarely went to an ER.  The study suggests there is ample room for interventions to help people avoid ERs and hospitalizations near the end-of-life.   (HA Article)