Health Care Insights | Weekly Round Up

Health Care Insights brings you your weekly healthcare round up. Below you will find relevant articles on key industry topics that we thought our readers would benefit from - enjoy.


Top Stories:

How The Upcoming Elections Might Shift The National Health Care Landscape
Here’s a solid prediction about next Tuesday’s elections: They’ll be crucial to the future of universal health care in America — or at least its near-term future.

Health Care Catches Data Fever
The United States is arguably in the midst of a health care crisis, but there is hope on the horizon and it involves learning how to make sense of big data. Over at Communications of the ACM, Oak Ridge National Laboratory (ORNL) shares how it is helping the health care industry benefit from patient data using the power of graph computing.

CFOs Feel Powerless When It Comes To Managing Healthcare Costs, Poll Finds
With U.S. enterprises spending more than $620 billion each year on healthcare costs, and nearly half of all Americans receiving their coverage through their employer, it’s no surprise that four out of five chief financial officers (CFOs) across all industries are feeling the pressure. In fact, nearly all CFOs (97%) believe that employers must “step-up” to the plate to help fix the broken healthcare system.

Omidria™ Granted Pass-Through Reimbursement Status from CMS
Omeros Corporation (NASDAQ: OMER) announced today that it has received transitional pass-through status for its lead product Omidria™ (phenylephrine and ketorolac injection) 1%/0.3% from the Center for Medicare & Medicaid Services (CMS), the federal agency that administers the Medicare program.

Health Groups Aim to Grow Pharmacists’ Care Delivery
Community Care of North Carolina (CCNC), GlaxoSmithKline (GSK), and the University of North Carolina (UNC) Eshelman School of Pharmacy have collaborated to generate new approaches to care delivery through pharmacists that will lower medical costs and improve health outcomes.

Have a great weekend!

Six Cases Where Big Data Can Reduce Healthcare Costs

Via Science Daily 

As electronic health record use becomes widespread across the United States, largely due to the implementation of the Affordable Care Act, the quantity of clinical data that will become available for research and analytic purposes will also dramatically increase. Experts in healthcare have become increasingly focused on clinical analytics that analyze large quantities of data for the purpose of gathering insights that have the potential to improve the value of patient care – a process that is known as big data.

In a new research study published in Health Affairs on July 8, 2014, researchers highlight some of the clearest opportunities to reduce costs through the use of big data.

Specifically, they discuss the role of algorithms in reducing cost in the following categories: high-cost patients, readmissions, triage, decompensation (when a patient's condition worsens), adverse events, and treatment optimization for diseases affecting multiple organ systems.

"The examples we present in this study provide key insights to the 'low hanging fruit' in healthcare big data and have implications for regulatory oversight, offer suggestions for addressing privacy concerns and underscore the need for support of research on analytics," said David Bates, MD, MSc, chief quality officer at Brigham and Women's Hospital and lead author on the study.

High-cost patients

Only 5% of patients account for about half of all U.S. health care spending. Bates and his co-authors articulate the issues that need to be addressed to identify and then manage these high cost patients. They include formalizing an approach to predict which patients are likely to be high cost, what measurements can be incorporated to improve this prediction, particularly those focused on mental health, and how to make these predictions actionable. Researchers emphasize that making new analytic systems effective will rest on the ability to make these predictions easily available to clinicians in a way that does not disrupt current workflow.

Readmissions
 
Researchers write that as many as one-third of readmissions may be preventable, which provides a significant opportunity for improvement in care and reduction in cost. Bates and his coauthors suggest that all health care organizations should use algorithms to predict who is likely to be readmitted, but highlight the challenges of implementing such algorithms. They include: tailoring the intervention to the individual patient, ensuring that patients receive the interventions intended for them, monitoring specific patients after discharge to ensure they do not develop issues that would cause their condition to deteriorate, and ensuring a low ratio false positive rate of patients flagged for an intervention to patients who experience a readmission.

Triage

Effective triage is essential to estimating the risk of complications when a patient first receives care in the hospital setting. This is important in order to manage staff and bed resources, ensuring the patient is sent to the correct unit for care and overall it informs the management of the patient's care. Researchers suggest integrating a triage algorithm into clinical work flow, and underscore the importance of having a detailed guideline to clarify how specifically the algorithm will inform care. Researchers examine two pilot studies which provide lessons learned in establishing effective triage algorithms.

Decompensation

When a patient's condition worsens, there is often a period in which physiological data can be used to determine whether the patient is at risk for decompensating. Researchers explain that the initial rationale for intensive care units (ICUs) was to allow patients who were critically ill to be closely monitored for this purpose. Researchers emphasize such systems can now be used throughout the hospital, and that effective analytic systems in this area must use multiple data streams to detect decompensation, as many new technologies are becoming available that can be used to better monitor patients.

Adverse events

Adverse events, while expensive and can result in high rates of morbidity and mortality, are preventable at high rates. Researchers call out three areas, renal failure, infection and adverse drug events, as specific opportunities to utilize big data to reduce costs.

Treatment optimization for diseases affecting multiple organ systems

Chronic conditions that span more than one organ system or are systemic in nature are some of the costliest conditions to manage. Autoimmune disorders such as rheumatoid arthritis and lupus frequently fall into this category and the ability to predict the trajectory of these diseases would immensely assist the caregivers deliver expensive therapies in a more targeted way. Focusing on the usefulness of big data in this area could result in effective approaches that can combine the many measurements taken as part of routine care to predict the progression of a patient's disease and personalize treatments and therapies appropriately. Access to health records with pertinent data has been the biggest limitation in adopting the use of big data in treating chronic diseases, but as the use of electronic health records becomes widespread, advances in this area are ripe for both improving patient care and reducing costs.


Researchers emphasize that these six cases are not an exhaustive list of the ways in which big data can be useful in improving value in healthcare. Specifically, they note that these examples, which focus on inpatient settings, will likely be transferrable to the outpatient setting as well.

"Support for research that evaluates the use of analytics and big data to address these six use cases, as well as thoughtful consideration of regulation and payment is warranted," says Bates. "Additionally, as multiple streams of data become available for analytic purposes, consideration of patients' privacy and their desire to link disparate sources of data will be of the utmost importance."



Source: This story is based on materials provided by Brigham and Women's Hospital.

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Healthcare costs see lower growth rate for 2012

For the first time in several years, healthare costs will only grow 7.1%, whereas over the last few years 9% has been the standard since 1997.  A few reasons for this, according to the Los Angeles Times, is the fact that many patients are staying away from doctors in the poor economy in addition to more health education which is keeping patients away from the emergency room.   Employers have also been making cost-cutting efforts by moving workers into lower-cost health plans or slashing expenses by raising insurance deductibles.

However, the cost cutting will still outpace of the growth earnings, which will leave employers with a need to find a way to cover the costs.  This will likely be through higher deductibles and copays.

What can employers and patients to next year to continue to slow the cost of growing healthcare rates?

Mandate minus price controls may increase healthcare costs

The Los Angeles Times reports that many experts believe an insurance mandate is vital to a healthcare overhaul. With everyone in the system, the nation's medical bill could be spread more broadly, alleviating pressure on those who have insurance to pay for those who don't. All of the major healthcare bills would penalize people who do not get health insurance.But Democrats have shied away from regulating premiums in the face of charges from business leaders and Republicans that controlling what insurers charge would be meddling too much in the private sector. As a result, while states have long supervised what companies charge for mandated automobile and homeowners insurance, the idea has been largely banished from the healthcare debate.

What do you think about the lack of price controls within the healthcare bill? Will this have a negative effect on healthcare costs for Americans? We'd like to hear your thoughts.

Mandate minus price controls may increase healthcare costs

Healthcare Co-Ops-- a Real Alternative?

The LATimes reports that congressional Democrats and Republicans are already sparring over an alternative to government-run insurance -- a series of private regional cooperatives that advocates say could achieve the goals of a public plan without the potential for government interference.

One of the six -- Democrat Kent Conrad of North Dakota -- is the leading Senate proponent of co-ops. He and others point to cooperatives in Seattle and Minnesota that employ doctors and own their own healthcare facilities, giving them more control over costs and the quality of care. Conrad says that under his plan, the federal government would play no role in managing the co-ops, but would only provide seed money to help them get started.

It seems that under this plan, some could choose their healthcare just like they choose a new apartment. But what about regulation of fees and fights over which doctors to choose for their co-op?

Healthcare co-ops emerging as viable alternative

Economy to Blame for Healthcare Payment Difficulties

More Americans are putting off health care costs due to the economic climate in 2009. Reuters reports that, Thomson Reuters, "conducted a Pulse survey of 100,000 homes to inquire about health insurance woes reporting that about 17.4% of homes admitted to postponing or waiting for health care in 2009." The report stated that, "40% of homes are postponing medical care for the next three months, with 15% foregoing regular doctor checkups." Homes that earned less than $50,000 per year were three times more likely to have trouble paying medical bills.

Aetna Drops on Rising Costs for Dismissed Workers

According to Alex Nussbaum at Bloomberg, Aetna Inc., the third-largest U.S. health insurer, slipped the most in two months in New York trading after the company said it was spending more than expected on health benefits for workers who lost their jobs or feared dismissal.
The shares dropped 10 percent, or $2.52, to $21.88 at 4:15 p.m. in New York Stock Exchange composite trading, Aetna’s biggest one-day fall since March 5. The Hartford, Connecticut- based insurer said expenses were pushed higher by dismissed workers who continued buying insurance through the government- subsidized Cobra program, as well as those who ramped up medical treatment as firings loomed.

Will more health insurance carriers face the same troubles as Aetna or will this be a temporary set back for the insurance giant?

Obama on Health care

Check out this video of President Obama's discussion with George Stephanopoulos regarding how his administration will look at managing health care costs and improving quality.

http://media.bulletinnews.com/playclip.aspx?clipid=8cb4275f6a44ad3

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