2012 Potpourri XXV

Towers Watson did a survey on onsite health center activity.  There were 74 companies in the survey, all of whom either have an onsite center or plan to open one soon.  The primary reason for having one was to enhance worker productivity, followed closely by a desire to reduce medical costs.  Services offered at the centers include biometric screening at 81%, urgent care at 70%, first responder at 70%, occupational health at 66%, primary care at 63% and EAP services at 52%.   Telemedicine is increasingly viewed as a way to expand the services offered.  New planned services often include wellness counseling and disease management.  Almost two-thirds of centers are run by an external vendor.  About a third allow spouses and children to use the center as well as employees.   (Towers Watson Survey)

The American Journal of Managed Care published a study examining patient loyalty effects of use of a personal health record at Kaiser Permanente Northwest.  Running from 2005 to 2008, about 400,000 members’ behavior was reviewed.  About 96.7% of members who used the personal health record available from the plan were retained or did not leave voluntarily versus 92.2% for nonusers.  Use of the record was a strong predictor of retention, only illness burden and longevity as a member were stronger ones in this analysis.  While few patients tend to use PHRs offered by plans, it appears that when they do, better loyalty results.   (AJMC Article)

A study in the Journal Health Care Management Review examined any effect from the insurance mandate in Massachusetts and hospital productivity.  Supposedly universal coverage will lead to more productive use of hospital resources.  Another blown rationale for reform!  The study found that while hospitals nationally gained 4.06% in productivity from 2005 to 2008, Massachusetts actually saw a drop of 3.53%.  The practical effect is that when the federal mandate goes into effect, the overall costs are going to be higher than expected because more hospital resources are going to be needed due to the drop in productivity.   (HCMR Article)

Research published in the Journal of General Internal Medicine also examined effects of Massachusetts reform, this time access to care for users of ERs.  About 430 patients who came to the ER of a large hospital between July of 2009 and March of 2010 were surveyed.  The most likely newly insured patients, those with Medicaid and a state plan for the poor, reported as much utilization of outpatient care and as good an access to a usual source of care as privately insured patients, but still reported delaying certain kinds of care because of cost-sharing.  In other words, if care isn’t completely free, people are still saying they can’t get all they want of it.  Absurd.   (JGIM Article)

According to research published in the Journal of Urban Health, adherence to cardiovascular medicines is not good among New York State Medicaid enrollees.  Looking at claims from 2008 and 2009 and using the medication possession ratio as the measure of adherence, the researchers found the overall adherence was only 63%.  Blacks, hispanics, younger people, females and those taking fewer drugs were less likely to be adherent.  Medication adherence is critical in chronic diseases and generally is thought to lower overall costs.  When the taxpayers are funding health care for patients, if they can’t be adherent and engage in other healthy behaviors, they should lose their eligibility.   (JUrbHealth Article)

MDLinx surveyed 673 physicians, with 254 in practices of ten or less doctors.  Of these small practice physicians over a quarter said there was a possibility the practice would close within a year.  Compared to employed physicians and those in larger practices, these doctors had more constrained income expectations in the coming year and feel overwhelmed by regulatory and other demands.  If this trend continues, the market for physician services will become  less competitive and patients will likely find fewer convenient, close-by alternatives for outpatient care.  Health care will be increasingly dominated by large health systems with market power in all care categories.   (MDLinx Survey)