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Above the Fold

Practical Advice to Employers On Managing A Health Plan – Lynn Jennings

Apr 1, 2008• 3

On blogs like this, people like me write analytically about issues which are often, at best, conceptual to us.Not so to the guys in the rough and tumble world of health care finance. I remember that the first time I went to dinner with Lynn Jennings, I only knew that he was CEO of Alliance Underwriters, working in reinsurance, and that he is a former President and a current Board member of the Self-Insurance Institute of America (SIIA). SIIA is the national association of third party administration firms, the organizations that administer health plans for self-funded employer health plans. As we were walking into the restaurant, he turned to me and said, "In reinsurance you make a very sizable bet and find out three years later how things turned out."Over time, though, as I’ve come to know Lynn better, I’ve found he has a profoundly practical view of the world, supported by a belief that careful management makes it possible for health care to work far better than it usually does.Here is his advice to employers on managing employer-sponsored health plans. Whatever your philosophical orientation, these are sound recommendations for employers who must grapple with the difficult choices associated with employee health benefits.

Brian Klepper

For 40 years, I have worked in the complicated world of self-insured
group health plans. I have led a third party administrator (TPA),
underwritten stop-loss coverage and, with my wife Judy, overseen a
utilization management firm. Now I’m also building employer-based
clinics.

Ratings games

Mar 31, 2008• 9

By Jane Sarasohn-Kahn

Most Americans believe there are fair and reliable ways to gauge the quality of health care. 9 in 10 Americans are interested in their health plans having a website where you could rate doctors on issues like trust, communications, medical knowledge, availability and office environment – and participating on such social networks (think: The Health Care Scoop, or Zagat/WellPoint).

The latest Wall Street Journal/HarrisInteractive survey published March 25 finds that 3 in 4 consumers favor patient satisfaction surveys – once again asserting they value opinions from peers (aka “people like me”) even more than those coming from institutions, whether private sector (e.g., employers or health plans) or public (e.g., government agencies).

Nonetheless, consumers still do value other sources for ratings:

– 66% like medical boards
– 65% value assessments by third parties, such as JCAHO
– 64% of consumers like measurements on preventive screening tests
– 58% believe the use of EMRs is a proxy for quality
– 42% see malpractice suits as a useful measure of quality health care.

The timing of this poll nicely coincides with the news that Angie’s List – known for its home repair service ratings – launched a health care ratings service earlier this month. On Angie’s List, consumers will be able to rate some 50 types of health care providers – including doctors, dentists, pharmacies, hospitals and health plans.

Which way to go for health reform? From Birkenstocks to pom-poms

Mar 31, 2008• 1

By Sarah Arnquist

The methods proposed to clean up the health care mess in the United States that leading voices pitched to hundreds of journalists Friday unsurprisingly were as varied as their Birkenstocks and patriotic tie.

David Himmelstein, co-founder of Physicians for a National Health Program and Birkenstock-wearing Harvard Medical School professor of medicine, unrelentingly pushed a single-payer system. "We need a reform that helps the insured as well as the uninsured," he said, adding that the system should "get rid of the insurance companies that provide no added value."

At the other end of the spectrum, Tom Miller, resident fellow at the American Enterprise Institute conservative think tank, wants more tax credits to put consumers in the driver’s seat and deregulation of the individual market.

Between those two ideologies, were Karen Davis, president of The Commonwealth Fund, and Julie Barnes, deputy director of the New America Foundation‘s health policy program.

Medicare releases hospital patient satisfaction data

Mar 29, 2008• 8

By Sarah Arnquist

Before choosing a hospital for an elective procedure, patients can now use the Centers for Medicare and Medicaid Services’ Hospital Compare Web Site to see how former patients rated their experiences at various hospitals. Patients can compare hospitals based on how well patients felt the doctors and nurses listened to them, whether the patients felt respected by the hospital staff, and whether patients understood the instructions on what to do after leaving the hospital.

Patients can also use the Hospital Compare Web site to compare how many patients were treated for heart attacks, pneumonia, and various surgeries at nearby hospitals and see how much Medicare paid.

These are the federal government’s latest steps to promote "value-driven health care."

"Everyone ought to have a motivation to get better quality and lower costs," said Michael Leavitt, secretary of the U.S. Department of Health and Human Services.

CMS launched the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data Friday before a group of hundreds of journalists gathering in Washington D.C. for an annual conference.

Dennis Quaid takes on hospital errors

Mar 28, 2008• 35

By Sarah Arnquist

Hospital patient safety has a new celebrity advocate in Dennis Quaid, whose twin newborns received a massive overdose of a blood thinner last year at Cedars-Sinai Medical Center while being treated for infections.

While his twins bled profusely, Quaid and his wife, Kimberly, were met by a hospital risk management team, who instead of offering an apology and explanation, provided half-truths and excuses, Quaid told hundreds of journalists Thursday at the annual Association of Healthcare Journalists Conference in Washington D.C.

The Quaids’ experience has been widely covered in the press, and he and his wife recently started The Quaid Foundation to shine a spotlight on the 100,000 people who the Institute of Medicine estimates die annually from preventable hospital errors.

"Unfortunately this tragic secret in the medical industry will continue until the medical community overwhelms a conspiracy of silence and demands public accountability,” Quaid said. "I do realize that because I’m a known person, we have an opportunity to get the word out."

Rebuilding The Medical Home: What Walgreens Surely Sees

Mar 27, 2008• 11

By Brian Klepper

Though it probably went mostly unnoticed in the cacophony of health care stories, last week’s news that Walgreen’s had bought the two largest and most well-established worksite clinic firms, iTrax and Whole Health Management, was a harbinger of very big changes in health care. Walgreens, the ubiquitous drugstore company that, with Wal-Mart and CVS, has already leveraged its pharmacy platform to establish a strong footprint in retail clinics, undoubtedly startled many health care observers with its announcement. After all, isn’t the company doctor a relic?

Actually, no. The worksite clinic – and by way of disclosure for the better part of the last year I have
worked closely with a small, very innovative, Orlando-based startup worksite clinic
firm, WeCare TLC – has been
reinvented and refitted with 21st century tools, and offers the promise
of nothing less than a paradigm shift toward dramatically better care
at significantly lower cost. Understanding how these structures work and how they differ from both old-fashioned medical practices and retail clinics provides clues into what Walgreens likely sees and why that matters to American health care.

Happy Birthday, Viagra!

Mar 27, 2008• 3

By Jane Sarasohn-Kahn

It’s the drug that raised the profile of medicine in popular culture. It’s been hawked by a prominent politician and has been the butt of jokes on late-night TV. It’s Viagara, and it’s turning 10 today.

The FDA approved the drug on March 27, 1998. Here is the FDA’s approval page for it.

Pfizer’s Viagra reshaped pharmaceutical marketing in several ways. The company used direct-to-consumer advertising to great effect, and changed the game of DTC by advertising the drug not only in late at night broadcast outlets.

More broadly, the marketing of Viagra bolstered the trend of medicalization of everyday life. Viagra’s origin as sildenafil citrate was targeted to cardiovascular medicine. Originally conceived as a heart drug for hypertension and angina, the molecule was, serendipitously, found to be useful in erectile dysfunction.

In 1998, three scientists who studied the dynamics of nitric oxide, the secret sauce in Viagra, won the Nobel Prize.

Jane’s Hot Points: One of the most informative primers on Viagra is this book from Meika Loe of Colgate University. In it, she observes that we are Viagra nation where, "our sexual status quo has shifted dramatically." Ten years after Viagra’s entry on the health scene, the search remains for a "pink viagra," a version for women. No one can deny the game-changing role that Viagra has played in American health care and in popular culture.

THCB readers will not be surprised …

Mar 26, 2008• 11

By Eric Novack

Cancer patients covered only by Medicare face problems getting chemotherapy …

Massachusetts Health Plan underfunded

Average Time of Discharge: Why a Hospital is Not a Hilton

Mar 26, 2008• 7

By Robert Wachter

Do you get as annoyed as I do about being pressured on your “Time of Discharge?” I just received my monthly report, and we’re in The Doghouse again: our average TOD – 3:28 pm – is hours after “check-out time.”

But when did we turn into the Holiday Inn?
Robert_wachter

Let’s start by appreciating where this comes from. Many hospitals, including mine, tend to run full – given the huge fixed costs of operating a modern hospital, being full is probably the only way you can be profitable, just like the airlines. Queuing theory (don’t tell me you’ve forgotten your queuing theory!) tells us that, when you’re full, you should look for fundamental choke points and do your best to relieve them. There are PhDs working for McDonald’s whose lives are dedicated to figuring out how to avoid lines at lunchtime rush hour, and others working in aviation who model the best ways to load passengers onto planes (latest answer courtesy of a Fermi Lab astrophysicist: start in the back and load every third row, back to front, sequentially).

The main stenosis in hospitals occurs in the early afternoon: the morning’s OR cases are finishing, the ED is heating up, the clinics are sending over elective and urgent admissions, the respiratory therapists have done their weaning and “liberated” a few patients from vents… and everybody needs a floor bed. Now! But they’re all taken, since nobody’s gone home yet.

Gridlock. Bad for business.

How do you fix this? About a decade ago, some smart consultant (I can’t figure out who, but he or she must have had a terrific PowerPoint slide making this point since every hospital I know of picked up on it) came up with the solution: let’s measure and report the time of discharge by service, shining the holy light of transparency on service chiefs like me to get them cracking. And since everybody likes Goals, how about we set a guideline – “The Discharge Time on 5 South is 11 am” – and post it in every room and nurse’s station. Then it won’t be a shocker to the patients when we try to hustle grandma into the wheelchair and roll her out of her room before noon.

Prosecution in organ harvest case faces hurdles at trial

Mar 25, 2008• 4

By Sarah Arnquist

Although neither the prosecution nor defense has shown its entire case, the unusually long eight-day preliminary
hearing for transplant surgeon Hootan Roozrokh revealed considerable details about what happened during Ruben Navarro’s final hours and the hurdles both sides must overcome at trial.

San Luis Obispo County prosecutors jumped their final pretrial hurdle March 19, when a judge ruled that a jury would decide whether Roozrokh committed dependent adult abuse Feb. 3 and 4, 2006, at Sierra Vista Regional Medical Center in San Luis Obispo.

Never before in the United States has a transplant surgeon been tried criminally under similar circumstances, and the transplant and medical communities have followed the case closely. No trial date has been set, but if the preliminary hearing is any indication, the trial likely will be lengthy with many witnesses and substantial expert testimony.