2010 Potpourri XXXIV

Health Fitness has published a case study on savings for a large employer from wellness programs.  Eastman Kodak was the employer and over several years use of incentives and other methods increased HRA completion and participation in various wellness programs significantly.  Using a pre and post study design, the firm also found that it had a positive overall ROI on the program of 3:2, with the greatest contribution coming from the physical activity and education program components.   (Health Fitness Brief)

Another positive for the effects of tort reform on health spending is found in research published in the American Journal of Emergency Medicine.  The authors assessed how likely a woman who presented in an ER with a head injury was to have an imaging study in states with and without several types of tort reform.  The researchers found that the more tort reform laws there were, the less likelihood an imaging study would be ordered.  This supports the notion that limiting malpractice laws could lead to less defensive medicine and lower costs.   (AJEM Article)

As mobile health has expanded rapidly, more concern arises about regulatory approaches, particularly from the FDA, which has held recent workshops on the issue, including a major joint meeting with the FCC.  The Wireless-Life Sciences Alliance issued a recent comment on regulatory approaches to the FDA.  Among its suggestions were to consider the risk of not allowing the mobile innovation to reach the market, consider the specific use of the product and rely of post-marketing surveillance to identify potential safety issues.   (Wireless Assoc. Comments)

As Medicare and other payers implement various pay-for-performance programs, there is interest in ascertaining the current quality of care in the areas covered by the programs.  Medicare has proposed a set of standards regarding hepatitis C treatment and research published in the Annals of Internal Medicine reports on the extent to which current care appears to meet those standards, finding that compliance ranged from 21% to 79%, depending on the indicator.  Care provided by a combination of primary care and specialist doctors appeared to be more likely to meet the standards.   (Annals Article)

Cardiocom and Aultcare released a paper detailing the results of a remote monitoring program on Aultcare members.  Aultcare used a Cardiocom product to monitor certain key measures for members with CHF, and has since extended the program to include diabetes, COPD and hypertension.  For the CHF population, Aultcare says the program saved about $5,500 per patient per year, which appears to be net of the cost of the intervention.  The paper also gives some useful examples of lessons learned during the program, such as not requiring physician authorization and managing by exception.   (Cardiocom Paper)

CMS is taking a step back on defining a new method for reimbursing pharmacies for Medicaid covered prescription drugs.  Due to concerns and a lawsuit regarding the AWP methodology, the entire industry has been looking for alternatives to serve as the basis for product cost in reimbursement.   In particular CMS is withdrawing provisions relating to calculation of average manufacturer price and the federal upper limit.  Pharmacies generally were encouraged, but given the financial distress of most state Medicaid programs, it seems unlikely that significant increases in payments are on the way.   (CMS Proposal)