2012 Potpourri XXI

The Health Care Service Corporation, the Blues plan in Texas, Illinois, Oklahoma and New Mexico, released results of a study of consumers in its high-deductible plans.  The study followed members who were in traditional coverage and moved to a CDHP and examined their health behavior and health costs before and after the change.  This group was more likely to use preventive care, reduced utilization by an aggregate 12%, were 10% more likely to use generics and had a 12% decrease in ER visits.  For employers who offered a full replacement CDHP, spending was reduced by an average of 14.4% over a three-year period.   (HCSC Story)

One of the research foci for the large PBM Express Scripts has been medication adherence.  In research released by the company, a failure to take prescribed medications was linked to excess hospitalizations for heart disease and high blood pressure.  The research was conducted on over 500,000 Americans 65 or older and used a measure of whether they had medicine on hand to determine adherence, which is a proxy with some issues.  For both conditions there are inexpensive generics so cost should not be a factor, but one in four of the subjects was non-adherent to statins and one in seven to hypertension medications.  For the least adherent group, there was a 28% greater risk of hospitalization for statin users and a 31% greater risk for hypertension drug users, as well as a greatly increased risk of ER visits for those patients who did not adhere to their prescriptions.    (Express Scripts Release)

Another piece of research describing how Americans often misuse their drugs was released by Quest Diagnostics, a large lab company.  The company conducts urine testing on samples ordered by physicians who are monitoring patient drug use.  The sample included about 76,000 tests, but the results should not be inferred to the larger population, as Quest did, because obviously doctors are more likely to order testing on patients they are concerned about.  In this sample, however, about 63% of the patients were not taking prescriptions as ordered, either not taking the drug prescribed, taking other drugs not prescribed, including illegal ones, or taking the prescribed drug with ones not prescribed, which raises the risk of interactions.  Given the number of deaths and other problems caused by drug misuse, the study gives further warning about the need to find better ways to monitor these issues.   (Quest Release)

Two articles in Science discuss whole genome sequencing and its application to health care.  Since the initial excitement around the sequencing of a human genome, it has been a long, slow slog to find clinically useful tests and treatments using genetic data, but they are becoming more prevalent.  Now the notion of sequencing each patient’s entire genome seems within reach, as costs may drop to the $1000 area.  More difficult is proving the clinical utility of this data as that requires significant randomized and other trials.  Handling all this data and making it available at the point of care is a huge undertaking.  And actual gene expression patterns and downstream biochemistry is more complex that just reading genetic code.   (Science Article)   (Science Article)

A Perspective in the New England Journal of Medicine examines why we seem to be getting so little bang for the buck in health information technology investments.  As in other industries, these investments don’t seem to have a rapid productivity payoff.  Unfortunately, the proponents of all the new health IT initiatives tend to paint glowing pictures of administrative and health care cost savings, which most research has to date shown don’t materialize.  The reason, as the authors point out, is probably because accompanying the IT investment is the need for comprehensive re-engineering and training in regard to new care processes.  In the absence of that, all the new IT can actually raise costs and user dissatisfaction.   (NEJM Article)