2012 Potpourri XXXI

An article in Health Affairs discusses the effect of payer/provider collaboration in an accountable care scheme for Maine Medicare beneficiaries.  The payer, Aetna, and a physician IPA collaborated on data sharing systems, care management and financial incentives.  For the managed population, there were 45% fewer hospital admissions, 50% fewer hospital days and 56% fewer readmissions than for the statewide unmanaged Medicare population; and overall costs were 16.5% to 33% lower.  Quality measures were high.  While the risk scores for the populations were similar, it is not clear that there were not differences that could account for the improvement, but this looks like a potentially valuable model.  (HA Article)

An article in Science magazine discusses a different approach to changing health behaviors.  This approach is based on the notion that much health behavior is not deliberate and thoughtful, but instead is an automatic response to stimuli in the environment and biochemical factors.  Therefore, information and education-based behavior programs are unlikely to work.  Interventions that target automatic behaviors are likely to be needed.  The authors suggest several population based interventions, including restricting marketing, manipulating people’s associations with healthy and unhealthy behaviors, altering environments to encourage healthy behavior, increasing healthy options and making them easier to obtain than unhealthy ones and changing product design.  Not mentioned: the most obvious, financial incentives for engaging in healthy behaviors, financial penalties for engaging in unhealthy ones.  (Science Article)

Research reported in the Annals of Internal Medicine describes the outcome of a study of EHR use at Kaiser Permanente and diabetes care.   The authors looked at whether two measures–glycemic control and LDL-C level–improved for patients in clinics with an EHR more than they did for patients in clinics still using paper-based records.  Almost 170,000 patients were included and on an adjusted basis, it appears that use of an EHR is associated with improved rates of appropriate medication intensification, follow-up monitoring and glycemic and lipid control.  Patients with the worst disease control seemed to show the most improvement.   In most cases, however, the improvement was modest.  (Annals Article)

A Perspective in the New England Journal of Medicine looks the moderation in health care spending in recent years, proposing a method of measuring it and analyzing potential causes and whether it might continue if the economy improves.  The authors claim that just comparing health spending to GDP provides a misleading picture when there are recessions and recoveries, but it is unclear why this should be so.  In any event, they compare spending to a theoretically consistent GDP at full employment and by this measure find that excess spending moderated in 2006, before the recession, became somewhat higher as the recovery began and has moderated again recently.  If compared to general inflation, however, a different story would be seen, as spending growth has stayed consistently well above inflation.  Any moderation, however, is welcome.  (NEJM Perspective)  

Another Health Affairs story reports on a medical home pilot in Colorado.  The pilot was conducted with 6 health plans and 16 primary care practices, covering about 100,000 patients.  A preliminary analysis suggests that the pilot reduced emergency room visits and hospital admissions, especially for patients with multiple chronic diseases. Some quality measures improved as well.  Some payers reported a return after investment after considering the additional costs of supporting a medical home model.  Other payers, primarily self-funded employers, however, balked at paying the higher fees associated with the pilot.  There were also data and other infrastructure challenges.  (HA Article)