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2010 Potpourri XLIII

By December 11, 2010Commentary

A study conducted by Milliman for the PBM Restat looked at whether using a select pharmacy network could lower costs.  Traditionally, almost every pharmacy has been included in a PBM or health plan’s network and all with the same copays or other financial incentives.  Recently, plans have begun to look at tiered networks with different cost attributes.  Milliman found that using a closed network with select pharmacies and better pricing could save up to 13% on drug costs.    (Restat Paper)

Medication adherence is a clinical quality problem and for transplant patients adhering to an immunosuppressive regimen is particularly important.  New research tests the use of telecommunications and remote monitoring to provide intensive support and feedback to patients regarding use of drugs.  The intervention sharply increased adherence and is likely applicable to other conditions where drug compliance is critical to good outcomes.   (Drug Study)

Research published in the Annals of Internal Medicine looked at whether a hospital’s for-profit status was associated with readmission rates, particularly when the readmission was to a different hospital.  A hypothesis was that for-profit hospitals might have an incentive to avoid caring for known high-cost patients.  In fact, 28% of patients initially hospitalized at for-profit facilities were subsequently readmitted to a different hospital, compared to 21% of patients at a non-profit hospital.  Lower volume and medical school hospitals were also associated with higher rates of readmission at a different facility.  Costs were higher for patients readmitted to a different facility as well.   (Annals Article)

Researchers examined studies on the costs and payback times for use of electronic health records in an article published in the Journal of Telemedicine and eHealth.  The authors categorized various costs and benefits used in the research and found that most EHR implementations appeared to have relatively rapid paybacks on both the capital cost and ongoing annual costs, but that there were instances where no payback appeared to have occurred.   (JTE Article)

The Atlantic Monthly carries a story regarding dialysis and dialysis patients.  For obscure historical reasons all dialysis is covered by Medicare, which of course has led to the usual meanderings of a government health care program in regard to reimbursement and other regulatory aspects.  CMS has tried to keep costs under control which has created incentives to skimp on care, but at the same time overpaid for certain drugs, which led to their overuse.  Quality oversight is poor.  Better at this point to disband the program and turn dialysis over to private payers.   (Atlantic Story)

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