January 2009

Healthcare Topics and Trends Update

CHRT's monthly online newsletter, providing convenient access to recently-published articles relating to healthcare quality, sustainability and access.

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Access to Care

More Nonelderly Americans Face Problems Affording Prescription Drugs

Center for Studying Health System Change, January 2009

According to a new study by the Center for Studying Health System Change (HSC), one in seven Americans under age 65 reported not filling a prescription in the previous year because they couldn't afford the medication, up from one in 10 in 2003. Rising prescription drug costs and less generous drug coverage likely contributed to the growth in nonelderly Americans-from 10.3 percent in 2003 to 13.9 percent in 2007-who went without a prescribed medication. The most vulnerable people-those with low incomes, chronic conditions and the uninsured-continue to face the greatest unmet prescription drug needs. Uninsured, working-age Americans saw the biggest jump in unmet prescription drug needs between 2003 and 2007, with the proportion rising from 26 percent to almost 35 percent. At the same time, a growing proportion of working-age Americans with employer-sponsored insurance reported going without prescription medications. The number of Americans who cannot afford prescription medications is likely to grow as the economy continues to decline and the ranks of the uninsured grow.

Coronary Artery Disease

Telephone coaching following hospitalization for acute coronary syndrome adds little to in hospital counseling

AHRQ Research Activities (on ahrq.gov), February 2009

This study showed that individuals who received telephone coaching for 3 months after being hospitalized for acute coronary syndrome (severe chest pain or heart attack) were 1.5 times more likely to engage in exercise for those 3 months, even though that declined once the telephone counseling ended. However, there was no significant difference between the counseled and non-counseled groups in medication use, odds of smoking cessation, and participation in weight loss efforts 3 and 8 months after hospital discharge, and no difference in functional status or quality of life 8 months after discharge. In hospitals that do not have QI protocols, telephone counseling may act as a reminder to a patient to raise these issues with a clinician. See "Does outpatient telephone coaching add to hospital quality improvement following hospitalization for acute coronary syndrome?" by Dr. Holmes-Rovner, Manfred Stommel, Ph.D., William D. Corser, Ph.D., R.N., and others, in the September 2008 Journal of General Internal Medicine 23(9), pp. 1464-1470.

Healthcare Costs

Rising Out-Of-Pocket Spending For Chronic Conditions: A Ten-Year Trend

Health Affairs, Jan./Feb. 2009 (Subscription required to view full text)

This study examined the prevalence of self-reported chronic conditions and out-of-pocket spending using the 2005 Medical Expenditure Panel Survey (MEPS) and made comparisons to previously published MEPS data. The study found that the prevalence of self-reported chronic conditions is increasing among not only the old-old but also people in midlife and earlier old age. The greatest growth occurred in the number of people affected by multiple chronic diseases, a group with sizable out-of-pocket spending. This article highlights the importance of understanding cost sharing, when done at the point of care, can disproportionately burden people with chronic conditions and discourage adherence to drugs that prevent disease progression.

Medicare PPO

What Works In Chronic Care Management: The Case of Heart Failure

Health Affairs, Jan./Feb. 2009 (Subscription required to view full text)

This study reanalyzed data from ten randomized clinical trials of heart failure care management programs to determine how program delivery methods contribute to patient outcomes. The study found that patients enrolled in programs using multi-disciplinary teams and in programs using in-person communication had significantly fewer hospital readmissions and readmission days than routine care patients had. The evidence base of what works in chronic care management programs is underdeveloped. This study offers policymakers and health plan administrators important tools for developing an evidence base on which to build effective policy and programmatic initiatives for chronic care management, particularly relevant for the Medicare population where CHF is a top condition.

Patient Centered Medical Home

Money and the Changing Culture of Medicine

New England Journal of Medicine, January 8, 2009 (Subscription required to view full text)

This article describes the medical practices as a business and the current economic culture within. Many business managers believe that clinicians will change their behavior to meet the imperatives of increased efficiency, cost containment, and improved quality only by increasing their focus on the flow of money in their work environment. Results from studies in behavioral economics and psychology suggest that there may be unintended consequences to assigning a monetary value to every aspect of a physician's time and effort. Including: reduced productivity, which results in impaired quality of performance, and thereby even increase costs. The authors of this article suggest that the Patient Centered Medical Home may be the way to restore the balance back into medical practice. They suggest that policymakers extend the PCMH to include medical specialists and also take into account the lessons of behavioral economics. Specifically, that caregivers should be appropriately reimbursed but should not be constantly motivated by money.