November 27, 2001

MOUNTAINS BEGINNING TO MOVE? THE MEDICARE CHRONIC CARE IMPROVEMENT ACT OF 2001 

One of the greatest barriers to delivering coordinated chronic care -- perhaps THE greatest barrier -- has been the lack of appropriate reimbursement. 
With support from the National Chronic Care Consortium (NCCC) and the Chronic Care Coalition, Congressman Pete Stark and Senator Jay Rockefeller have introduced The Medicare Chronic Care Improvement Act of 2001. This legislation is designed to update and improve the Medicare health delivery system to meet better the needs of people with chronic health conditions. 

The Institute of Medicine's (IOM) recent report, "Crossing the Quality Chasm", pointed out the centrality of reforming medical reimbursement payment policies:

"...to achieve the aims of the 21st century health care system...it is critical that payment policies be aligned to encourage and support quality improvement.... Even among health professionals motivated to provide the best care possible, the structure of payment incentives may not facilitate the actions needed to systematically improve the quality of care, and may even prevent such actions. For example redesigning care processes to improve follow-up for chronically ill patients through electronic communication may reduce office visits and decrease revenues for a medical group under some payment methods." 

While the likelihood of passage for this specific legislation is unclear, it does create a focal point for coalition building. This legislation SHOULD draw support from a wide constituency of health care organizations with common interests in promoting the IOM's vision of future health care, including e-health companies, telemedicine, pharma, medical information technology, medical devices, provider groups, etc. Contact Rich Bringewatt, President and CEO of the NCCC, to express your support!

STEADY PROGRESS: 3 NEW REPORTS ON PHYSICIAN USE OF E-HEALTH TECHNOLOGIES

"Vital Signs Update: Doctors Say E-Health Delivers"
Harris Interactive and Boston Consulting Group; November 13, 2001
 
Some key findings:

	...physicians use the Internet widely to increase their medical knowledge.
	The busiest practitioners are most likely to turn to the Web to enrich their professional knowledge. This makes the Internet a powerful vehicle that pharmaceutical companies, managed care organizations (MCOs), and health-care-delivery systems can use to reach doctors who regularly see a large number of patients.
	The information that doctors are finding online is influencing-in many cases significantly-the types of diagnoses they are making and the kinds of medications they are prescribing.
	...a small number of high-traffic medical sites are emerging as potential vehicles for reaching a large number of doctors online. The doctors who have used the tools find them highly effective. They say that electronic medical records, electronic prescribing, online communication with patients, and remote disease monitoring have significantly boosted their efficiency and the quality of the care they provide.

Commentary: ...it's worth reading every word of this report...the BCG/Harris Interactive analysis is insightful and thorough.

"Innovations in Physician Prescribing"
by Protocare Sciences for the California HealthCare Foundation, October 2001

Findings:
The key to influencing prescribing behavior is to make information or decision support available to the physician at the time a prescription is written.

Keys to success:

	Alignment of incentives
	Physician commitment and involvement
	Availability of financial and staffing support
	Objective and consistent "counter-detailing" education (regarding appropriate choices for medications)

"Wireless and Mobile Computing"
First Consulting Group for the California HealthCare Foundation (CHCF), October 2001

This is a great primer on mobile and wireless technologies for health care applications. Keys for success include:

	Understand the integration of workflow, information flow and technology.
	Set user expectations
	Learn from experience
	Pilot the application

LEADING JOURNALS SPOTLIGHT CHRONIC CARE ISSUES

Two leading journals have recently devoted special issues to the topic of chronic care needs:

Meeting the Needs of Chronically Ill People
British Medical Journal; October 27, 2001

Chronic Illness in America
Health Affairs, November/December 2001

HEALTH PRIVACY PROJECT POINTS TO FLAWS IN HIPAA

"Exposed Online: Why the new federal health privacy regulation doesn't offer much protection to Internet users"
Health Privacy Project, Institute for Health Care Research and Policy, Georgetown University
Sponsored by the Pew Internet & American Life Project, November 2001

Key findings:

	The new federal health privacy regulation does not apply to most health Web sites.
	Different rules may apply to different Web sites offering the same services.
	Even at Web sites that are owned or operated by organizations covered by the privacy regulation, it is ambiguous which activities at those sites are subject to the privacy rule.

DOUBLE DIGIT HEALTH CARE BENEFIT COST INCREASES PROJECTED FOR 2002

It's the time of year when health care benefit consultants project employer health care cost increases for the upcoming year. Projections for 2002:

Watson Wyatt.......13.6%
Andersen..............11.7 - 15.5%
Towers Perrin........14%
Hewitt...................13 - 16%

Read the details:
Watson Wyatt

Andersen

Towers

Hewitt

A key question: Over the past 2 years, a number of initiatives have arisen to place a renewed emphasis on health care quality. Will these initiatives be given true support or lip service in light of continuing double-digit health care cost increases?

NBCH ANALYSIS -- EMPLOYER SURVEY SHOWS EMPLOYEE INVOLVEMENT IN THEIR OWN CARE MANAGEMENT AS BEST WAY TO BATTLE INCREASING HEALTH CARE COSTS 

"August-September Employer Survey Results: Cost Containment Strategies"
National Business Coalition on Health (NBCH)

Click here to read the Press release or Survey summary.

Half of the employers surveyed believe employee involvement in managing their own care will have the greatest impact on reducing health care costs.

TELEMEDICINE PAYMENT POLICIES - GOOD NEWS, BAD NEWS

"Telemedicine: Follow the Money"
Online Journal of Issues in Nursing; September 30, 2001
Dena S. Puskin, Sc.D.

This article presents a 10-year overview of Medicare telemedicine reimbursement policies. It is written by the foremost expert on the subject -- Dena Puskin, Sc.D. - who since 1998 has served as the Director of the Office for the Advancement of Telehealth (OAT) of the U.S. Health Resources and Services Administration (HRSA). The office currently manages 80 telehealth programs in 43 states.

The bad news - the OAT is being "abolished" by HRSA. What will happen to the tremendous strides made to improve telemedicine payment?

HEALTH PRIORITIES AFFECTED BY 9-11 ATTACKS

"Americans' Health Priorities Revisited After September 11"
Health Affairs; November 13, 2001

Findings: 

	In both relative and absolute terms, health care is a much lower priority than before September 11.
	The impact of these events has led Americans to have become more concerned about a range of serious diseases, including cancer, heart disease, HIV/AIDS, diabetes and others.
	The public is now concerned about the health effects of terrorism.

Implications:

	Concerns with bioterrorism will also lead to strong public support for major initiatives to improve our public health system.
	In contrast to health problems, health care issues have become less salient to the public. This is likely to lead to decreased support for government action on health care issues that were being debated by the Congress before September 11. These include Medicare reform, a Medicare prescription drug benefit, patients' rights legislation, and coverage for the uninsured.

CARING FOR CHILDREN WITH ASTHMA

"Asthma Care for Children: Financing Issues" 
Center for Healthcare Strategies, October 2001 

Disclosure -- No clients were mentioned this issue.



E-CareManagement News is an e-newsletter that tracks a major change in health care and managed care—the paradigm shift from “managing cost” to “managing care”.  This e-newsletter is brought to you by Better Health Technologies, LLC (http://www.bhtinfo.com).  BHT provides consulting and business development services relating to disease management, demand management, and patient health information technologies.

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