Everything is Getting Faster, Including Health Care

By |2017-10-09T02:06:12+00:00November 15th, 2016|Health Care Trends, Retail Health, Uncategorized|

Everything is Getting Faster, Including Health Care

In Robert Colville’s book released this summer, The Great Acceleration, he explains a variety of ways in which the world is getting faster and faster. It is a worthwhile read and certainly aligns with current demands across the health care system that service times accelerate.

Additionally, the election of Donald J. Trump as 45th President of the United States on November 9, 2016, and the alignment of Republican majorities or control in Congress with more than half of state legislatures and governorships, is likely to mean rapid changes to health care policy – striking while the iron is hot, so to speak.

Health care corporations are already focused on this trend of acceleration. For example, CVS Health (NYSE: CVS), the large pharmacy chain and pharmacy benefit manager, explained two very interesting acceleration trends in its 2016 third-quarter earnings. The first relates to its retail clinic business. CVS now operates more than 1,100 clinics in 33 states and Washington, D.C., including the retail clinics inside Target (NYSE: TGT) stores. Most news coverage about CVS Health’s earnings focused on the fact that they recently lost their position as a preferred pharmacy provider for some federal government clients. Also of note was that revenues are up nearly 25% for the retail clinic business from last year, and the “Hold My Place in Line” online queuing tool is used by 33% of CVS Health patients.

People might be sick, but they don’t have time to wait in line.

Second, CVS also mentioned the (so far) great customer ratings of its new Curbside Pickup service which was launched in 40 markets and 4,000 stores in September. The graphic below explains the effort.

cvs

Source: CVS Health Curbside Pickup

Hopefully people aren’t using the Curbside Pickup app while they drive, but this is certainly meeting the customer where she or he is. If you don’t have time to park, CVS has got you covered.

Walgreens (NYSE: WBA) also made a big foray into speed this summer, announcing a partnership with Mental Health America and MDLive to improve access to mental health services via telehealth. Part of the effort is to help visitors to Walgreens’ website use free screening tools and surveys to determine their mental health status and whether they need additional help. Patients are able to use the online tools then receive referrals to the Mental Health Association website or click to an MDLive telehealth resource called Breakthrough that delivers therapy wherever you are.

The tagline? “Mental Health Therapy From Your Couch.” Or what New York Times bestselling author, Susan Shapiro, has called “Speed Shrinking.” (Shapiro’s Twitter description starts with “Instant-gratification-takes-too-long…”) Health care organizations that don’t keep up will lose customers, lose revenue, lose relevance.

Faster care. More convenience. Accelerated times to serve the (im)patient/customer. Everything is getting faster, including health care. Are you ready?

Millions of Men Screened for Prostate Cancer Despite Evidence to Stop

By |2017-10-09T02:06:47+00:00November 7th, 2016|Uncategorized|

Millions of Men Screened for Prostate Cancer Despite Evidence to Stop

Despite the fact that the U.S. Preventive Services Task Force (USPSTF) has recommended against using prostate-specific antigen (PSA) testing, physicians continue to use this as a method to screen men for prostate cancer in the U.S.

According to a review of data on 92 million men presented recently by Centers for Disease Control and Prevention (CDC) researcher Shahram Shahangian, Ph.D., the impact of the recommendations has been “very modest,” with a roughly 10% decline in utilization since the Task Force’s 2008 recommendation against use of PSA-based screening for prostate cancer in men younger than 50 and older than 74. (In 2012, the Task Force revised its recommendations, urging against any PSA-based screening.)

Beyond this modest overall decline in PSA-based screening, “the fact that testing continues in the older population, where there should not be any testing done, is very disappointing,” Dr. Shahangian told Medscape.

It’s interesting to note some groups believe there is still a limited role for PSA screening. For example, the American Urological Association recommends offering PSA screening to men 50 to 69 years old who have a minimum of 10 remaining years of life expectancy, as long as there is informed consent and shared decision making between the health care provider and patient.

Dr. Yair Lotan of University of Texas Southwestern’s Harold C. Simmons Comprehensive Cancer Center told Urology Times, “One of the problems is if you follow the U.S. Preventive Services Task Force recommendation against PSA screening and don’t even discuss it with patients, you are not giving your patient the important option of screening. You have to be honest about discussing the pros and cons and help inform patients about the value of PSA testing.”

Why does the U.S. health care system continue to reimburse for testing that is no longer based on the latest evidence?

When the evidence does not support a health care intervention, who should pay? When a patient is warned PSA screening is no longer recommended, as suggested by Dr. Lotan as part of shared decision making, but the patient wants the screening anyway, should they have to pay for it?

There is a relatively easy fix for this persistence of non-recommended testing; both public and private payers could simply stop reimbursing for the test. However, cases like this point to a broader question: who gets to decide whether and when a widely used and accepted practice, particularly in oncology, should no longer be paid for?

Cardiac Rehab Programs: Yet Another Evidence-Based Intervention That Isn’t Paid For

By |2017-10-09T02:07:38+00:00November 7th, 2016|Evidence-Based Medicine, Social Determinants of Health, Uncategorized, What do we pay for and why|

Cardiac Rehab Programs: Yet Another Evidence-Based Intervention That Isn’t Paid For

Evidence shows cardiac rehabilitation programs –which teach patients who have had a cardiac event about exercise, diet and prescription drugs – substantially cut the risk of dying from another cardiac problem; they also improve quality of life and lower costs. But as Kaiser Health News notes, fewer than one-third of patients whose conditions qualify for cardiac rehab actually participate.

One of the main reasons for the low participation rate is cost; patients must generally pay a co-pay to participate in such programs – about $20 per session for regular Medicare beneficiaries, and anywhere from zero to over $60 per session for Medicare Advantage enrollees and those who are privately insured.

Aside from cost, other barriers include distance/travel time to the facility, lack of referrals at the time of hospital discharge, and capacity of existing cardiac rehab programs. This is particularly troubling because in spite of the increased likelihood of death within five years of a first heart attack, certain populations are less likely to be referred for cardiac rehabilitation, including women, minority populations and patients of lower education levels of socioeconomic status.

[Note to readers: I am a bit obsessed about the evidence for cardiac rehab, as well as the social determinants of health that prevent it from being routinely recommended and included it as Case 17 in the textbook I co-edited, Essential Case Studies in Public Health: Putting Public Health into Practice, published by Jones and Bartlett.]

What do we pay for, and why?
In considering innovation and value, there are frequently situations in which patients are receiving a health care service that runs counter to recommendations based on the latest evidence- clearly a waste, but politically difficult to stop, especially if it runs counter to patient or provider preferences. However, this is an example of where the evidence clearly supports reimbursing for the intervention, but the service is underutilized considering its value to the patient and the system.

As noted, this low participation rate in cardiac rehab is due in part to patients’ reactions to time requirements, but can also be blamed on health insurer cost-sharing requirements that discourage use of a valuable intervention. To be clear, studies show 25% reduction in all-cause mortality rates and 31% reduction in hospital readmissions, translating into millions in annual savings.

Medicare is inching forward with its Cardiac Rehabilitation (CR) Incentive Payment Model which pays hospitals incentive payments based on total cardiac rehabilitation use for patients in their care after a heart attack or bypass surgery. Hospitals can receive $25 per cardiac rehabilitation service for the first 11 services they provide and the payment increases to $175 per service after those first 11 services.

If the evidence shows significant reductions in adverse events and cost of care for those who participate, is it time for payers to reflect that increased value in lower co-pays? And perhaps more importantly, is it time for payers to require providers to recommend cardiac rehab for everyone who could benefit, regardless of their gender, race or income?

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