Weekend Potpourri VIII

By December 19, 2009Commentary

The New Jersey Health Care Quality Institute released a report on hospital costs and charges in the state.  (NJ Report) Hospitals’ stated prices are four times higher than their actual costs.  The national average is 2.8 times.   Private and public payers don’t pay anything near these stated charges, but the uninsured get bills based on them, which is ludicrous.   The hospitals claim they are willing to negotiate downward, which begs the question of why prices are set that high to begin with.  The report also displays very, very wide variation in stated prices among the state’s hospitals.  The report serves a valuable purpose in creating greater transparency but it raises a lot of questions about what is going on with hospital price-setting.

Mobihealthnews put out an annual report on the state of wireless health in 2009.  The report summarizes perspectives on market size, initiatives from carriers and other organizations, venture investing and transactions.  The report anticipates good progress ahead for the wireless health industry, with the expected primary caveat being ability to obtain reimbursement from payers or consumers.  (Wireless Report)

Genomics company DNA Direct announced that it has received URAC accreditation for its health utilization services.  Many of the genetic testing companies started out pitching the advantages of their tests to consumers.  They soon realized that consumers are interested in having someone else pay for the services, so they began to orient their marketing to payers.  DNA Direct claims it can help payers manage the utilization and utility of genetic tests.   (DNA Press Release)

A Carnegie Mellon researcher has created a database which shows your relative risk of dying in various countries and the database also has health cost information.  (Carnegie Release) The research  found that costs in the United States per capita are comparable to those in other developed countries up to about age 60.  Thereafter, spending in the US skyrockets compared to those other countries.  For example, we spend over $40,000 annually on people over 80 and Germany spends only about $10,000.  On the other hand, people are more likely to die at these ages in other countries.  According to the data amassed in this study, it appears that our excess spending is all due to how much disease we have as we age and how we treat those diseases.

For many years PBMs have attempted to position themselves as managing care or even disease.  The latest example is an arrangement between Medco and Coventry whereby they will collaborate in a study seeking to reduce hospitalization of the elderly by using a team-based approach that more intensively tracks a patient’s health and health care needs.  The team will include a Medco clinical pharmacist, as well as other health professionals.  Aside from the now relatively common approach to managing care better for elderly patients, it is very interesting to see a health plan and a PBM actually sponsoring and paying for what appears to be a very rigorous randomized clinical trial of a care method.  (Medco Release)

Researchers at UCLA looked at pay-for-performance programs in California, examining their impact on patient care experiences, including physician-patient communication, office staff interaction and care coordination.  (Journal Article) They found that the programs had generally improved measures of patient satisfaction with care.  Within physician practices, however, incentive payments that were used to fund broad practice improvement initiatives seemed to have a positive effect, whereas incentives paid directly to physicians and tied to productivity measures seemed to worsen the patient experience of care.

Leave a Reply