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2010 Potpourri VI

By February 20, 2010Commentary

America’s Health Insurance Plans is the trade association for most of the commercial health plan companies in the United states.  It has attempted to use the association not just for public policy but to encourage its members to find solutions to health care issues.  One such effort was announced recently, a collaboration of health plans in New Jersey to use a single portal for physicians to conduct administrative activities in regard to the plans.   (AHIP Release) The insurers represent 95% of commercial members and this initiative, which allows eligibility and benefit checks real-time, claim submission, and claims status checks, should be helpful to physicians in lowering the time and expense associated with getting paid.

Comparative effectiveness research has been pushed as one significant method to ensure only appropriate care is delivered, presumably lowering costs and improving quality.  A Wall Street Journal article demonstrates how hard that may be to achieve in practice.  (WSJ Article) The Journal article focuses on stents and a trial which showed they had little benefit for certain patients as opposed to treatment with drugs.  If the trial’s results were used to guide medical care, as much as $5 billion a year could be saved.  Doctors, however, have every financial incentive to keep using the stents (the average interventional cardiologist makes $500,000 a year) and the stent manufacturers are certainly not going to discourage their use.  As the article notes, unless policymakers provide payers with cover for using the results of trials, it will be hard for them to take on physicians and product companies over appropriate care issues.

Another Wall Street Journal article describes a new blood test that will help guide cancer treatment.  (WSJ Article) One of the significant hurdles to effective cancer treatment is deciding when it is or isn’t likely that a patient has been cured or is likely to relapse.  Knowing the answer can help avoid unnecessary chemo or radiation therapy or ensure that a patient’s disease is treated aggressively.  Researchers at Johns Hopkins used the DNA from a patient’s cancer cells to determine whether the cancer had likely been eradicated.  The genetic test looked specifically at certain code rearrangements and found a clear correlation with the cancer status.  The ability to use such tests in routine clinical practice is facilitated by the sharp fall in the cost of sequencing.

A study published in the Public Library of Science Medicine examines whether greater use of value based insurance designs could improve health and  reduce health.  (PLoS Study) The essence of such designs is that treatments shown to be cost effective and health improving would have reduced patient cost sharing and those that do not fit this category would have higher copays and deductibles.  The study used a model to see what the likely effect of widespread use of this benefit design would be.  The most interesting finding may be that about 60% of health expenditures are on low-value services.  The study concludes that value based insurance design could improve health and savings used to expand access without increasing costs.

A Journal of the American Medical Association commentary recommends use of population-wide improvement measures and programs as a method to improve quality and coordination of care.  (JAMA Commentary) The author believes that focusing only on incentive programs aimed at individual hospitals or physicians, an opportunity is being missed.  Incentives that are measured by improvement in all persons in a geographic area would force greater cooperation and lead to better care for more people.  Regional and provider variation in care would also likely be reduced.

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