Quality Data - The Public Does Not Believe

Consumers using the Internet trust Web sites providing illness cause and treatment data, but are wary of Web sites providing quality information, according to research presented in an America's Health Insurance Plans online seminar.

Metavante Healthcare Payment Solutions contracted with Change Sciences Group to conduct the online interactive survey. More than 500 participants in August 2007 were asked to visit the Web sites of several insurance and financial companies and quality organizations to search for information on back pain and evaluate their experiences.

As consumer-driven healthcare continues to grow, AHIP is exploring patients' perspective of health-savings accounts and trying to determine what would make consumers want to enroll in high-deductible plans. While most of the research was designed to answer that question, some of the survey responses indicated that consumers turn to the Internet for information about health conditions and how to treat them, but quality information still is not used.

Consumers trusted information about cause and treatment about 80% of the time, according to Metavante's research. They trusted quality data about 40% of the time.

I have been saying for some time that consumers do not understand quality data. This data should be in the purview of physicians who use it to guide patients. And still you have to be cautious. Whose data do you use let alone believe? And how long until the public becomes savvy enough to know that hospitals just like others are paying these quality survey agencies to use their name if they happen to show favorable results. The public needs to be aware of hospitals that advertise quality ratings as the data is old as soon as it arrives. Physicians not the public need to step up. And should universal health care ever materialize there should be one universal set of quality standards that everyone uses.

But that's my opinion. What's yours?

You Can Lead a Senior to Water but…..

The Centers for Medicare & Medicaid Services launched the Medicare Health Support pilot project three years ago hiring eight private disease management firms to set up voluntary chronic care improvement programs for beneficiaries. At its height 150,000 seniors were enrolled in the program. 68,000 beneficiaries still receive services.

By using trained nurses or health coaches to contact patients
and remind them to check their vital statistics and take their
medications, among other activities, the companies encouraged
the seniors to take better care of themselves between office visits.
The desired result was fewer unnecessary hospitalizations and
emergency department trips.

CMS has determined that the pilot was not meeting the statutory requirement that enrollees' Medicare claims amounts be lower than or equal to those for a control group of seniors who were not enrolled in the project. Three of the original eight disease management companies dropped out before their three years was up. Medicare Health Support will terminate in December and not be renewed unless the five remaining firms help slash enrollees' Medicare claims by $600 to $800 per participant per month from now until the contracts end.

So is the focus on costs clouding the fact that some quality improvements have been made? Apparently so according to physicians fighting to keep the program alive, citing for example some improvements in quality scores for seniors in Western Pennsylvania. Another problem seems to be the availability of data on enrollees that could help the disease management companies better gauge what they have to provide and how far they have to improve the health of the beneficiary. Indeed improvements have been made just perhaps not within the cost metric that CMS wanted so it is hard to tell if the program truly worked at its core mission level. And apparently beneficiaries chosen for these services may indeed have been too sick for them to do much good. Physicians say a redesigned program would need to involve physicians heavily in choosing which beneficiaries would benefit from the chronic care services.

So perhaps this is the right intentioned program with the wrong carrot. In any case it would be great to see some of the empirical evidence on quality improvement as well as hear the anecdotal stories of seniors helped by it. It would be a shame to thwart something that is finally wellness and not sickness related. What do you think?

Good Marketing or Just Plain Nuts

Alliance Community Hospital in Ohio has publicly done what most marketers think about secretly but never do. They have outrightly asked their community members to share information on the prices and charges that they have encountered as patients at their competitors. And they have offered a bribe, I mean payment, of $100 per insurance company information provided up to $1,000.

It wants patients to hand over their bills and corresponding ''explanation of benefits,"statements from insurance companies that detail how much hospitals charge for procedures and treatments, as well as how much insurers and consumers actually end up paying.

The hospital CEO said it is part of the hospital's attempt to provide consumers with more information about the true cost of medical services and plans to share the information eventually on a new Web site. As on insurer noted "looking through EOBs from unrelated facilities poses issues of data collection, interpretation and validity. Moreover, there may be numerous legal issues inherent in such an effort.''

The hospital is seeking patient insurance statements from 2007 for inpatient stays, emergency room visits, MRI and CT scans and physical therapy.

OK, I give the marketers some credit for having the, well you know what, for just asking. Hey why not. However, the thing about insured consumers is that they are well, insured and as long as they have the card and free entry into the system, they will not comparison shop on price. They will go where their physician tells them and through what they have heard from word of mouth. And even those in high deductible plans may find it very confusing to go through EOB statements and to understand what are charges versus what is the actual price to pay.

To me this is a slick way to gather competitor intelligence that does not have a whole lot of upside. In fact, it just feels unethical. But hey that's my opinion. Tell me yours.

Institute of Medicine Study Warns Boomers Better Take Care of Themselves

The Institute of Medicine released a report Monday on the health care outlook for the 78 million baby boomers about to begin turning 65. It was not rosy. In short, there aren't enough specialists in geriatric medicine; insufficient training is available; the specialists that do exist are underpaid; Medicare fails to provide for team care that many elderly patients need.

Medicare may even hinder seniors from getting the best care because of its low reimbursement rates, forcing physicians to cut back on the number of Medicare patients they treat.

And as we have been saying for a while, the health care system is not geared toward managing chronic conditions and is woeful at coordinating care with multiple providers.

Sens. Senators Barbara Boxer, D-Calif. and Susan Collins, R-Maine have introduced a bill to steer caregivers towards geriatric and long-term care roles, and create an advisory panel to analyze this critical sector and make recommendations to tackle its changing needs. The report also urges that all health care workers be trained in basic geriatric care and that schools increase training in the treatment of older patients.

OK, all well and good but let’s face it, this will only happen over time and many of these boomers will be well within the throes of managing their health care. Sage advice coming – not really. So again what does it come down to? Self-responsibility. Plain and simple. We as a nation have to start taking better care of ourselves. Estimates show that every other boomer will have arthritis. Every third will be obese. Every fourth will have diabetes. Six out of ten will have multiple chronic conditions. Much of this is preventable. And then not only do you have the health problems, you are going to have to pay for more of the care you receive. Prepare yourselves.