Thanksgiving Potpourri

By November 26, 2009Commentary

Safeway has quantified savings from its much-touted wellness program.  (Safeway Article) In a presentation at the annual National Business Coalition on Health, the retailer said it had saved a total of about $150 million through this year and expects that number to rise to $230 million next year.  The company returns about 60% of the savings to employees in premium rebates.  Safeway employees who control their weight, don’t smoke, control blood pressure and reduce cholesterol are eligible for the rebates.  Safeway says a smoker costs an incremental $1405 annually, an overweight person $1400 and one with uncontrolled blood pressure, $600.  In addition to changing employee behaviors, the company has examined medical procedure costs and capped the amount it will reimburse at a level consistent with that charged by lower cost providers.  It would be interesting to see what widespread adoption of these simple approaches would do to national health spending.

Another example of creative use of mobile and wireless technologies was reported in HealthCare IT News.   The article reports  on a network of physicians using the technologies to care for chronic wound patients.   (Telehealth Article) These patients typically have poor quality of life and can be quite expensive.  Clinical staff are able to visit them and to share information digitally and teleconference with experts.  The patient saves time and discomfort from not having to be transported to doctors’ offices as much and it is likely that there is a savings in hospitalizations.  Notwithstanding reimbursement challenges, these technologies are finding adoption among creative medical practices.

Medco issued a marketing piece masquerading as a press release which was nonetheless informative about the PBM’s strategy.  (Medco Release) Referring to its approach as “Smarter Medicine”, Medco lists the elements of its services that it says can improve quality and lower costs.  Medco has been quite successful in attracting new business this year and attributes that success to its focus on clinical effectiveness and managing physician prescribing behavior and consumer engagement.  Medco’s clients must be satisfied and the program has apparently been very successful in controlling costs for those clients.

Deloitte has a series called Deloitte Debates which briefly and succinctly cover a current topical area.  A number of the Debates relate to health care and a recent one looked at pharmaceutical company sales and marketing, in particular the heavy reliance on sales reps.  (Deloitte Debate) Increasingly physicians will not even see drug company reps and even those who do allow them in don’t view them as unbiased sources of useful information.  The Debate takes the drug company, provider and payer perspectives and examines possible alternatives.  This is an interesting topic because drug companies spend a lot of money on sales reps and it is not clear what the return is, but it is also not clear what the alternative might be.  If sales reps and DTC advertising were eliminated completely, drug company costs would go down substantially and that cost reduction could be passed on to customers, but the drug companies would feel completely at the mercy of outside forces to determine the sales of their products.

Mercer has released a summary of the results of its survey on employer health costs.  (Mercer Survey) According to the survey of over 2900 employers, costs rose about 5.5% in 2009, the lowest increase in a decade, to about $8945 per employee annually.  Unfortunately, because there is no inflation, the gap between health cost increases and general inflation actually grew larger.  Large employers are relying on wellness programs and care management to limit costs and small employers are increasing their use of high deductible plans to shift cost increases to employees.   Another interesting finding is that a fourth of large employers have an on-site medical clinic for work health problems and over 10% for general health issues.

Research reported in the Annals of Internal Medicine reviews two self-management interventions to control blood pressure.  (Annals Abstract) The study compared usual care, a behavioral self-management intervention focused on diet, smoking cessation, exercise, etc.; home blood pressure monitoring; and a combination of the behavioral intervention and home BP monitoring.  The behavioral intervention was conducted by a nurse in bimonthly phone calls.  The outcome measured was blood pressure level.  Both interventions improved blood pressure control, the home monitoring more than the behavioral intervention and the combined intervention yet more.  The research is another example of the use of relatively low-cost technology to enhance health outcomes.

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