Employers and health insurers are asking consumers to put ‘more skin in the game’ with high-deductible health plans but don’t provide incentives for them to choose high-value care.
On the one hand, the PCMH is an admirable effort to gather in one place all the disparate and disorganized clinical and social supports the patient needs. At the same time, though, medical homes employ provider-defined business models and conventional performance measures, belying the patient-centered in the name.
At first patients didn’t care that much. Then the monitors improved, and studies showed improved outcomes. But CMS wouldn’t cover them unless they had a ‘nonadjunctive’ indication. Now some envision a time when fingersticks will be a thing of the past for many people with diabetes.
An age/sex/gene expression score helped to identify patients with low current likelihood of obstructive coronary artery disease. These patients had lower costs of CAD care during one year of follow-up. Early reductions in cardiac referrals at 45 days among these patients persisted for one year.
It’s no mystery why this country has both the highest per capita health care costs and the lowest overall percentage of people with coverage. The two are connected, but as if on a teeter-tooter: As one goes up, the other goes down.
The breast cancer mortality rate in 2012 declined 49% compared with the expected baseline, and 63% of that reduction was from treatment drugs. You’d think that patients would take their cancer medicines no matter what. But when cost sharing reached between $100 and $500, the abandonment rate soared to 32%.
The authors of Understanding Value-Based Healthcare provide this rationale for their book in terms of how to go about improving health care: “Government cannot do it. Payers cannot do it. Regulators cannot do it. Only the people who give care can improve it.”
Resource use and exacerbation among patients with COPD are weighed in a preliminary study. Subjects treated with a combination of long-acting muscarinic antagonists (LAMA) and long-acting β2-adrenergic agonists (LABA) cost more to manage than those receiving LAMA alone, although emergency department and outpatient visit costs were less. The authors say those starting the LAMA+LABA therapy may have more severe COPD.
The architects of Medical Episode Spending Allowance benefits are radically reframing coverage as allowances for episodes of care and have a plan for engaging members in making better choices.
A federal bill would expand access to experimental treatments, but critics say right to try would take away FDA oversight and create a ‘Wild West.’ Meanwhile, most states’ right-to-try laws have gone unused.
The FDA’s work to redefine ‘truthful and non-misleading’ communication may preempt state efforts.
Some hospitals are making house calls these days as they experiment with delivery of high-intensity care in people’s homes. Taking the hospital out of hospitalization might be safer and less expensive than conventional inpatient care. Median direct costs of the home patients were half that (52% lower) of the control patients who received conventional hospital care.
Price transparency, payment reform, and consumerism are needed to bring market forces to health care. Too many managed care organizations are comfortable with the status quo.
Geisinger’s goal is to be not just one of the top health care organizations, but one of top organizations among all the companies in the United States.