Musings from the conference on disease management…..it’s hot in Boston but a few musing from presentations

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Cheap interventions in DM work. Cutting co-pay costs to close to zero and adding pharmacists doing education for chronically ill people in a commercial population makes a big difference.  Barry Bunning runs the Asheville project (in North Carolina) which has a ten year history of this and have seen costs for this group go down by about half over that time—with success even in the first years, even though it cost several hundred dollars per patient—and saw continued trend reductions versus comparable national stats. Pretty damn interesting and perhaps we don’t need much more higher tech information.

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Medecision (Henry DePhillips, med director)—started with putting the payers in the business of predictive modeling and matching and is putting that information in the hands of the docs during the physician patient relationship….but claims that only 13–5% of provider data is ready to be assessed, whereas of course none of the personal health record stuff is, and of course all the data has got the payer, and that’s all extractable and electronic. So they can present it in what they call the PBHR (payer-based health record). Their patient clinical summary extracts data from payer systems, summarizes it, and moves it to the doc at point of care. The summary has:

• demographic information,
• main diagnoses,
• a health status measure (derived from the data) 
• a medical problem list,
• then inpatient or ED admissions (with discharge information) in recent years,
• useful CPT data from physician visits (including not yet the lab test, but the fact there was a test and who ordered it with their phone number),
• the medication list,
• doctors already seen
• and finally the nursing plan of care content. 

Designed for ER docs—most useful is medication list, then docs they’ve seen and phone number, and previous test knowledge. Will be modifying this out. Have already interfaced this into 5 personal health records, to pre-populate. But the main way it’s used is printed out by the triage clerk in the ER  or by the front desk clerk in a physician office,.

Just got the results of a financial study (from HealthCore) looking at the use of this in a trauma center over about 9 months (with cases and controls) 918 visits and transmissions. If you take into account the ER episode plus the first day of hospital admission saved $545 per transmission of the record. This showed also NO difference in hospital admit rates. What were the differences? Lab costs much lower; cardiac cath costs much lower as previous; medical and surgical supplies costs lower; physician cognitive care component INCREASED in this population, which probably means that they made the unknown known (i.e. the patient was actually sicker so needed more) . So the payer saved, the doc made slightly more, and the hospital saved on ER throughput time (theoretically can see 9,000 cases more per year, although they make less on each case!)

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I met someone emblematic of the problems of employer based health care. She’s an RN who moved jobs and in the process was financially devastated by first her kids four days in pediatric intensive care after an asthma attack (somehow this was pre-excluded from her employers insurance) and then immediately afterwards her husband needing a by-pass. She was five years from paying off her mortgage with no debt, and now will never be able to retire. Only after the third hospitalization did she realize that the hospital would give them a discount, and of course they charged her the rack rate. She said the worse thing was not knowing about all the potential social support—including from the hospital. This is a straight case of someone working hard, playing by the rules and being totally screwed by the health system.

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Also heard an amazing talk from Dave Moskowitz from GenoMed. Dave has been on THCB before, and he believes that he can reverse disease….and that consequently the entire medical establishment has been shutting him out. Amazing stuff; I of course have no idea if it’s true, but I have a sneaking suspicion that he understands the incentives pretty well!