Craig Keyes
Craig Keyes

I saw my doctor last month for an annual physical. I cannot imagine a better primary care physician; he’s so thorough, so kind. After an exhaustive review, he said all seemed pretty much “ship shape,” but he had to add one dig: “Hey, I was glad to hear you finally went for your screening colonoscopy. Thing is … I can’t find any evidence that it actually happened. No claim, no entry into the electronic medical record, nothing. Did you end up having the procedure?”

Busted!! It’s true that I went to have the procedure, and I shared this with my doctor. What I didn’t tell him was that I left before it was performed.

The U.S. offers the highest advances in medicine and technology, yet only 55% of patients receive nationally recommended guidelines of care for their health needs. There are many contributing factors, but gaps in care that go unattended top the list.

Krishna R. Patel, PharmD, RPh

Apps will begin to be prescribed by physicians by the end of this year. Call it disruption, innovation, or crossroad, but it will be here and the question is are we ready for it?

WellDoc has been selling type 2 diabetes apps, and will now be the first to launch a prescription app. Go ahead and search for “mobile diabetes management” on clinicaltrials.gov and what you find may surprise you. Just like drugs that must be approved by the FDA after presenting landmark clinical trials, BlueStar is a prescription app for Type 2 diabetes that was approved by the FDA upon showing efficacy and safety data.

Ford Motor Co. and Rite Aid are already catching on, as they have agreed to reimburse employees for using BlueStar through their prescription benefit plans. BlueStar manages patients’ disease by not only monitoring but also providing feedback to them and to their doctors.

Just as with any other drug, the health care provider prescribes the app for one month, along with refills. The prescription is received by the pharmacy, which runs it through the insurance company and also forwards the claim to WellDoc. A WellDoc trainer approaches the patient to set up the app on the patient’s mobile phone or laptop and also to provide instructions.

Jessica Cherian, PharmD, RPh

Will the FDA go back on a decision it made years ago? I am referring to a story that has a lot of buzz: whether or not the FDA will take recommendations from its advisory committee and change the restrictions on Avandia (rosiglitazone). Avandia was approved in 1999 and shortly became the top-selling type 2 diabetes medication in the world. In 2010, data from a number of trials convinced the FDA to severely restrict the medication through implementation of a Risk Evaluation and Mitigation Strategy (REMS), while Europe banned it entirely.

Paul E. Terry, PhD

Though the Department of Health and Human Services and Department of Labor issued final regulations concerning “Incentives for Nondiscriminatory Wellness Programs in Group Health Plans,”1 employers and health plans must still navigate unresolved inconsistencies between the Affordable Care Act (ACA) and the Americans with Disabilities Act (ADA).

The latest ACA rules indicate that if a plan uses a “health-contingent” incentive scheme, that is employees are to meet certain standards related to a health factor (e.g., losing weight or controlling blood pressure) in order to receive a reward in the form of reduced premiums or deductibles, the plan must satisfy several requirements including offering a “reasonable alternative standard” for those who believe that the standard is not accommodating their unique circumstances.  

The EEOC has remained silent on whether they deem wellness programs to be voluntary, a key concern of an agency committed to ensuring that all employees enjoy equal benefits and privileges of employment such as is guaranteed under the American with Disabilities Act (ADA).

Krishna R. Patel, PharmD, RPh

Research from the New England Healthcare Institute has the world rethinking what the next great advance in health care will look like. While many of us are only now beginning to hear the noise about medication nonadherence, health care leaders are already hot on the trail to finding effective ways to reduce nonadherence.

Steven R. Peskin, MD, MBA, FACP

At a recent Grand Rounds, a leading clinician medical ethicists told of a meeting with members of the family of a critically ill 6 week old boy who had been in a neonatal intensive care unit since birth. At the meeting were the mother and father, both sets of grandparents, an and aunt and uncle, three members of the hospital ethics committee and physicians and nurses who were caring for the seriously ill child. The one question that our speaker posed to the parents and any other family members that chose to offer a response:

Steven R. Peskin, MD, MBA, FACP

Alice found a Wonderland.

What we found last week, when the Center for Medicare & Medicaid Services (CMS) released cost information for the 100 most common diagnoses and procedures in over 3,000  hospitals, is beyond Alice’s imagination. Some of the cost differences for the identical billing diagnoses qualify for “you cannot make this stuff up.”

Two examples:

Steven R. Peskin, MD, MBA, FACP

We know Watson, the supercomputer, for its vast fund of knowledge and thinking prowess when machine bested man, defeating the all-time Jeopardy champ for games won, Ken Jennings (74), and Brad Rutter, Jeopardy’s highest money winner ($3,470,102), and winning against Jennings in a head-to-head Tournament of Champions. Now, Watson is flexing her considerable problem-solving muscle in medicine, and, more specifically, in clinical decision support. Indeed, the British edition of the online magazine Wired reports that “IBM’s Watson is better at diagnosing cancer than human doctors.” 

In September 2011, IBM and Wellpoint announced an agreement to create the first commercial applications of the IBM Watson technology to improve patient care. Watson has been a diligent medical student for the past two years, with a voracious  — perhaps insatiable  — appetite for both structured and unstructured data, including human language.

Robert Royce

Those seeking some clarity regarding the future of health care policy in the UK will be forgiven for being baffled by recent events. First up was an abortive attempt by the government to introduce a requirement for National Health Service commissioners (known as clinical commissioning groups – see my article on “Health Care Reform in England” in the August, 2012 issue of Managed Care to undertake formal market testing of services.

Steven R. Peskin, MD, MBA, FACP

Earlier today, I was speaking with a physician colleague about his commitment to continue to improve person-centered care in his primary care practice and to enhance patient experience. We talked about the potential value of greeters in the practice, of a patient council to offer feedback and recommendations, and, with training, increasing the scope of service of medical assistants to allow nurses, advanced practice nurses, and physicians to spend more time with more complex care.

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