Category Archives: Health Care

The Danger of Wellness Programs: Don’t Become the Next Penn State

Source: Tom Emerick and Al Lewis, Harvard Business Review Blog Network, August 20, 2013

…This whole slow-motion debacle would have been completely avoidable at many points in the last week or two… if only Penn State’s administration had had access to a search engine and a calculator.

The search engine would have told it that even the major academic proponents of conventional wellness programs don’t think they save money, that vendors make up savings numbers, that the screens they insisted upon can’t even theoretically save money and a whole body of research opposes them, and that all the extra preventive doctor visits they required were useless. (The search engine also would have told the school’s administrators that this scheme was highly unpopular among their employees.)

The calculator would have told them that their 43,000 covered lives probably incurred a total of only about 100 wellness-sensitive medical inpatient events, like heart attacks, of which a few might have taken place in people who were not previously diagnosed and were therefore at least theoretically avoidable, saving the tiniest fraction of their healthcare spending. …

2013 Employer Health Benefits Survey

Source: Kaiser Family Foundation and the Health Research & Educational Trust, August 20, 2013

From the abstract:
This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, and other relevant information. The 2013 survey included almost three thousand interviews with non-federal public and private firms.

Annual premiums for employer-sponsored family health coverage reached $16,351 this year, up 4 percent from last year, with workers on average paying $4,565 towards the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2013 Employer Health Benefits Survey.
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Summary
Press release

At the Crossroads: Providing Long-Term Services and Supports at a Time of High Demand and Fiscal Constraint

Source: AARP Public Policy Institute, July 2013

Tight fiscal budgets and increasing demand for publicly funded long-term services and supports (LTSS) are putting pressure on states to transform their systems of care for older people and adults with disabilities. Many states are beginning to implement Affordable Care Act LTSS options that increase access to Medicaid home and community-based services, but non-Medicaid aging and disability funding has either decreased or remained flat in most states.

Joint Commission Alert: Medical Device Alarm Safety in Hospitals

Source: The Joint Commission, April 8, 2013

The constant beeping of alarms and an overabundance of information transmitted by medical devices such as ventilators, blood pressure monitors and ECG (electrocardiogram) machines is creating “alarm fatigue” that puts hospital patients at serious risk, according to a Sentinel Event Alert issued today by The Joint Commission.

Reevaluating “Made in America” — Two Cost-Containment Ideas from Abroad

Source: Gerard F. Anderson, Amber Willink, and Robin Osborn, New England Journal of Medicine, Vol. 368 No. 24, June 13, 2013

Per capita spending on health care in the United States is more than double that in most other high-income, highly industrialized countries, yet performance on indicators of health status is often worse. The Institute of Medicine recently reported that there is a “strikingly persistent and pervasive pattern of higher mortality and inferior health” in the United States than in other high-income countries. We believe that this poor correlation between spending and outcomes should prompt a reevaluation of current cost-containment efforts…. For many years, articles have been written about the high prices that the United States pays for medical services and how all-payer rate setting, reference pricing, and global budgets could reduce the prices the United States pays for services. We examined two additional cost-containment pricing strategies that could be adapted to the U.S. health care context: a bundled-payment system from Germany and volume-driven pricing adjustment from Japan. These promising policies could be introduced as technical adjustments to the existing payment system rather than requiring large-scale reform — a possibility that renders the “uniqueness” argument moot. In addition, the international experiences could provide guidance on what the likely effects and unintended consequences would be if these approaches were adopted in the United States….

2013 Workplace Benefits Report: Employees’ Views on Achieving Financial Wellness

Source: Bank of America/Merrill Lynch, AR1D1838, 2013

From the press release:
Bank of America Merrill Lynch today announced findings from its 2013 Workplace Benefits Report, a study of the increasingly significant role financial benefit plans play in helping the American workforce achieve financial wellness. Based on a nationwide survey of more than 1,000 employees from companies of all sizes, this research offers new insights into the availability, utilization and evolution of these workplace benefits – from 401(k) plans and health savings accounts (HSAs) to financial advice and education.

Key findings include:
• More needs to be done to help employees confidently transition into retirement
• Tax – advantaged saving for medical expenses is becoming the norm, though many are saving less for retirement as a result of rising healthcare costs
• 401(k) contribution rates indicate that the majority of younger workers may be comfortable with an automatic deferral of 5 percent
• One out of four “pre-retirees” – employees who indicate being within five years of retirement – expects to have less than $250,000 saved
• Workers are willing to give up portions of their salary for guaranteed retirement income
• Employees are looking to their employers for access to one-on-one advice from a financial professional
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Old, Sick, Alone, and Poor: A Welfare Analysis of Old-Age Social Insurance Programs

Source: R. Anton Braun, Karen A. Kopecky, and Tatyana Koreshkova, Federal Reserve Bank of Atlanta, Working Paper 2013-2, July 2013

From the abstract:
Poor heath, large acute and long-term care medical expenses, and spousal death are significant drivers of impoverishment among retirees. We document these facts and build a rich, overlapping generations model that reproduces them. We use the model to assess the incentive and welfare effects of Social Security and means-tested social insurance programs such as Medicaid and food stamp programs, for the aged. We find that U.S. means-tested social insurance programs for retirees provide significant welfare benefits for all newborn. Moreover, when means-tested social insurance benefits are of the scale in the United States, all individuals would prefer to be born into an economy with no Social Security. Finally, we find that the benefits of increasing means-tested social insurance are small or negative, if we hold fixed Social Security contributions and benefits at their current levels.

Targeted versus Universal Decolonization to Prevent ICU Infection

Source: Susan S. Huang, Edward Septimus, Ken Kleinman, Julia Moody, Jason Hickok, Taliser R. Avery, Julie Lankiewicz, Adrijana Gombosev, Leah Terpstra, Fallon Hartford, Mary K. Hayden, John A. Jernigan, Robert A. Weinstein, Victoria J. Fraser, Katherine Haffenreffer, Eric Cui, Rebecca E. Kaganov, Karen Lolans, Jonathan B. Perlin, and Richard Platt, New England Journal of Medicine, Vol. 368 No. 24, June 13, 2013

From the abstract:
Both targeted decolonization and universal decolonization of patients in intensive care units (ICUs) are candidate strategies to prevent health care–associated infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA)….In routine ICU practice, universal decolonization was more effective than targeted decolonization or screening and isolation in reducing rates of MRSA clinical isolates and bloodstream infection from any pathogen.
See also:
MRSA Study Results, MRSA Study Slashes Deadly Infections in Sickest Hospital Patients
Source: Agency for Healthcare Research and Quality, Press Release, May 29, 2013

Health Care Spending and Efficiency in the U.S. Department of Veterans Affairs

Source: David I. Auerbach, William B. Weeks, Ian Brantley, RAND Corporation, RR-285-MTF, 2013

From the abstract:
In its 2013 budget request, the Obama administration sought $140 billion for the U.S. Department of Veterans Affairs (VA), 54 percent of which would provide mandatory benefits, such as direct compensation and pensions, and 40 percent of which is discretionary spending, earmarked for medical benefits under the Veterans Health Administration (VHA). Unlike Medicare, which provides financing for care when its beneficiaries use providers throughout the U.S. health care system, the VHA is a government-run, parallel system that is primarily intended for care provision of veterans. The VHA hires its own doctors and has its own hospital network infrastructure. Although the VHA provides quality services to veterans, it does not preclude veterans from utilizing other forms of care outside of the VHA network — in fact, the majority of veterans’ care is received external to the VHA because of location and other system limitations. Veterans typically use other private and public health insurance coverage (for example, Medicare, Medicaid) for external care, and many use both systems in a given year (dual use). Overlapping system use creates the potential for duplicative, uncoordinated, and inefficient use. The authors find some suggestive evidence of such inefficient use, particularly in the area of inpatient care. Coordination management and quality of care received by veterans across both VHA and private sector systems can be optimized (for example, in the area of mental illness, which benefits from an integrated approach across multiple providers and sectors), capitalizing on the best that each system has to offer, without increasing costs.

2013 National Health Insurer Report Card

Source: American Medical Association, 2013

From the press release:
Patients are responsible for nearly one-quarter of the medical bill, according to the findings released today from the AMA’s sixth annual check-up of health insurers and their patterns for processing and paying medical claims. For the first time, the AMA’s National Health Insurer Report Card examined the portion of health care expenses that patients are responsible for through copays, deductibles and coinsurance. During Feb. and March of this year, patients paid an average 23.6 percent of the amount that health insurers set for paying physicians.