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Humana’s happy news about value-based MA programs


Humana, the giant health-insurance company, reports that its Medicare Advantage members enrolled in value-based programs get better care and healthier outcomes than in  traditional fee-for-service programs — while helping to cut costs.

The company said it had 20 percent lower costs last year for members affiliated with providers in value-based reimbursement models compared with estimated  fee-for-service  Medicare costs.

Members with chronic conditions in value-based MA plans had better health outcomes on average than those not in such plans.  The Centers for Disease Control and Prevention has said  that chronic ailments are responsible for 86 percent of U.S. healthcare costs.

Humana, which manages the plans of 3.1 of the 18.5 million MA enrollees, said that 1.2 million of its MA members are affiliated with providers in value-based reimbursement models.

Humana also reported:

  • Providers  in value-based payment models had 19 percent greater care-quality scores than those in standard fee-for-service programs.
  • Emergency room visits were 6 percent lower for patients in value-based programs than in fee-for-service programs.

To read more, please hit this link.


The surging joint-replacement industry


The (Portland) Oregonian has done a nice review of the surge in the joint-replacement industry. That surge has been fueled by an aging population and heavy marketing by providers who see joint replacements as a bonanza.

Consider that “Knee replacements nearly doubled across the country between 2000 and 2010 to almost 720,000 operations, and hip replacements rose even more to 330,000 procedures, according to the latest statistics by the Centers for Disease Control and Prevention.”

And now on to improving diagnosis



This article in the New England Journal of Medicine looks at  the Institute of Medicine’s new report titled “Improving Diagnosis in Health Care — The Next Imperative for Patient Safety.”

The authors of the NEJM piece, Hardeep Singh, M.D.,  and Mark L. Graber, M.D., conclude:

“Now could be an opportune moment to create a national public–private partnership to propel progress. The Department of Veterans Affairs and the Agency for Healthcare Research and Quality have made commitments to improving diagnosis, but the Centers for Disease Control and Prevention, the National Institutes of Health, and the ONC also have interests that intersect with patient safety and could contribute to research and implementation initiatives for elucidating and reducing diagnostic errors. On the private side, a movement is being led by the nonprofit Society to Improve Diagnosis in Medicine, …which petitioned the IOM to study this issue and aims to spearhead a national coalition of professional societies and other interested parties to translate the recommendations into action.

“For the past 15 years, the patient-safety movement has focused on treatment-related harms. But interactions that are too brief to permit clinicians to listen to patients, productivity pressures, and reimbursement systems that don’t adequately support clinicians’ cognitive work are highlighting additional safety issues. ‘Improving Diagnosis in Health Care’ restores balance to the patient-safety quest by calling attention to diagnosis, the other half of medicine. We are optimistic that the report will spark a renaissance of interest in improving diagnosis and reducing patient harm from diagnostic error.”

Five levels in improving population health



Tom Frieden, M.D.,  director of  the Centers for Disease Control and Prevention, writes in The New England Journal of Medicine that providers must deal with five levels of a “pyramid” model to optimize public health.

He lists:

  • The base: socioeconomic determinants — income, employment status, race and education,  followed by, in this order:
  • Such public-health interventions as expanded health coverage or contraception access.
  • Long-term preventive interventions, such as immunizations.
  • Clinical interventions such as blood-pressure management.
  • Public education and outreach efforts.

Dr. Frieden says that major long-term population-health improvement depends on preventive and clinical interventions.

Some key elements in successful population-health initiatives include, he says:

  • Team-based care.
  • Patient-centered care.
  • Consistency.
  • Continual improvement in delivery and treatment.
  • Registry-based information systems.

Personalized-medicine focus seen threatening public-health efforts


1802 caricature of Edward Jenner vaccinating patients who feared it would make them sprout cowlike appendages.

Ronald Bayer, Ph.D., and Sandro Galea, M.D., both of the Columbia University Mailman School of Public Health, argue in The New England Journal of Medicine that the federal government and the healthcare industry’s focus on personalized medicine could hurt efforts to improve population health.

They argue that  precision medicine advocates’ focus on treatment  at the individual level means that they tend to ignore such  pressing concerns as  the United States’ low ranking among developed nations in care quality or socio-economic factors’ (aka the “social determinants of health”) big effect on mortality.

The authors say that  the Feds have invested about five times more in  National Institutes of Health research, increasingly focused  on individualized-care models, than in the Centers for Disease Control and Prevention.  And, they write, the proportion of NIH-funded initiatives with “population” or “public” in their names fell 90 percent in the last decade.

“Without minimizing the possible gains to clinical care from greater realization of precision medicine’s promise, we worry that an unstinting focus on precision medicine by trusted spokespeople for health is a mistake — and a distraction from the goal of producing a healthier population.”

Call for coordination against ‘super bugs’



In this antibiotic-resistance test, bacteria are streaked on the dish with antibiotic-impregnated white disks. Bacteria in the culture on the left are susceptible to the antibiotic in each disk, as shown by the dark, clear rings where bacteria have not grown. Those on the right are fully susceptible to only three of the seven antibiotics tested.

The Centers for Disease Control and Prevention are pressing health facilities in each region to share data with a central public-health facility to help stem the increasing number of drug-resistant “superbugs.” It  says that such sharing and coordination could save more than half a million lives over five years.

The Washington Post notes that “Hospitals or nursing homes try to control infections on their own, but they rarely tell each other when a patient being transferred into another facility is carrying antibiotic-resistant bacteria. That lack of information greatly increases the risk that the germ will be spread.”

In this area, too, America’s fragmented and exorbitantly priced health “system” needs to have more silos blown up.


CDC targets elderly in diabetes program


Video and text: The Centers for Disease Control and Prevention is targeting older people in a drive to prevent and control diabetes.

The agency notes:

“These past few years we have been setting up the National Diabetes Prevention Program (DPP). It has caused us to work with a variety of groups and a variety of populations. The original DPP research study demonstrated that the intervention is even more effective in patients older than 60 years of age. It is 58 percent effective for the general population and 71 percent effective for those older than 60 years of age. This is certainly a population that will benefit from this intervention. To that end, the Centers for Medicare & Medicaid Services has given out some grants to help study this.”

Given how bad diabetes is in itself and how associated  it is with other life-threatening and expensive ailments, most people will applaud this initiative.



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