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The doctor/patient relationship-Why not have our docs drive national reform? October 9, 2011

Posted by medvision in Chronic Disease, Employee Wellness, health data, Uncategorized.
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Over the past 25 years we’ve (insurance & consulting industry) created practically every process imaginable to control the financial aspects of employer sponsored health care. Indemnity, HMO, PPO, EPO, HDHP, HRA, HSA, consumerism, wellness, disease management, care management: All failing to control cost or quality.

The following was posted by English heart surgeon, Norman Biffra, MD,” Every Doctor and Medical Student must see this”

If this video doesn’t “rock you” you may be in the wrong field!  http://tinyurl.com/3jf7stz


Health-Benefit Costs Increase The Most in Six Years–Why? Industry answers sound like a “Twlight Zone episode” September 28, 2011

Posted by medvision in Chronic Disease, health data, Healthcare Costs, Insurance Plans, Uncategorized.
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Here’s one of multiple press accounts of the latest Kaiser Foundation poll: http://tinyurl.com/3u5oqmp A 9% trend climb in 2011 showing family coverage average cost of $15,073.  Why? Kaiser relates: The health law enacted last year accounts for 1 to 2 percentage points of the premium increases in 2011. And–Contributing to the rise in premiums are escalating prices for medical products and services, fewer young and healthy people in the insurance pool and new preventive benefits under the health overhaul, said Karen Ignagni, the chief executive officer of the Washington-based America’s Health Insurance Plans, said in a statement.

What a tap dance! Here’s what’s fueling cost–Uncontrolled Chronic Disease! Why can’t we see the elephant? Maybe the solutions are too involved to discuss?

The CDC is awake! http://tinyurl.com/4apmjdf Sounds scary? Is our national chronic disease status (one out of every two Americans) helped or hurt by the ongoing trend of increasing front end cost/imposing higher deductibles on consumers suffering from chronic disease? Are new preventative benefits adding to the cost and suffering impact of chronic disease?

Chronic disease is the enemy–not $60 physician visits. If diabetes left in an uncontrolled state can cost $1 million, why do we nickel and dime the 1st $5,000 of services which may prevent the huge claim?

Study: Many don’t take drugs because of cost March 31, 2011

Posted by medvision in Cancer Care, Chronic Disease, Employee Wellness, health data, Healthcare Costs, Healthcare Reform, Insurance Plans, Risk Management, Rx Costs, Uncategorized.
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Some have heard my negative thoughts concerning High Deductible Health Plans (HDHPs) as a strategy to control health cost and quality. I won’t go into a diatribe, but I argue  relate to lower cost and high quality in the manner “dynamite” relates to sturdy hillsides.  Here’s another study looking at “cost” as a member barrier to preventative/lower cost care management. http://tinyurl.com/4gjjfc7

A relevant risk management question: If a member with advanced type 2 diabetes cannot afford plan-dictated prescription drug co-pays of $300 per month, and becomes non-compliant, is the plan sponsor at higher risk of a “shock” claim?  My thoughts are: The risk bearer/employer is “short-sighted” in trying to manage Rx and medical risk in separate silos.

Hmmm? $300 per month Vs. potential vascular events, renal failure, blindness, renal transplant and potential multiple amputations? I’ll take the $300/month, please!

Take your medicine! March 28, 2011

Posted by medvision in Cancer Care, Chronic Disease, Employee Wellness, health data, Healthcare Costs, Insurance Plans, Risk Management, Rx Costs, Uncategorized.
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Some elements responsible for our national out-of-control healthcare inflation are amazingly simple. Maybe plan managers, government policy makers and clinicians should stop–and take a few deep breaths: 50% of Americans fail to follow their doctor’s instructions concerning prescription drugs”  The short form is: We aren’t taking our medicine. This fact lines up with a dated Rand study finding 50% of Americans fail to receive recommended care. http://tinyurl.com/4ev7dbc

Does this have a large impact on our healthcare inflation? As a splinter of evidence the attached WSJ article indicates up to 90,000 Americans die annually from the failure to take blood-pressure medication. Med-Vision’s experience shows (3) factors responsible for poor Rx adherence:

(1) COST–Today large health plan managers have virtually “unlimited liability” associated with the total cost of adverse health events. Where’s the logic in assigning co-payment/co-insurance cost responsibility to the members, in today’s economy, who cannot afford and thus guaranteeing the (low-cost compared to hospital stay) medicine necessary to prevent a catastrophic medical event are not taken? Imagine if physicians medication orders were ignored by nurses in the inpatient acute care hospital setting? The next time a consultant offers advice to increase drug co-pays across-the-board, as a cost control strategy, maybe it’s time to suggest for him/her look for a new client.

(2) Untreated/under-treated DEPRESSION: Depression is classified as a mental illness and carries a significant social stigma. Many doctors will prescribe antidepressants, and due to concern of the patient’s medical records, fail to record a depression diagnosis. Today’s ramped up levels of anxiety coupled with the absence of free time and worries about the economy are pushing depressive symptoms to higher levels. Why not change the name “depression” to emotional wellness, make it known to the workplace the prevalence of this disabling condition and relay it’s ok to seek help. Depression is one of the most “curable” conditions. Why do people suffering from depression fail to take medicine? Feelings of lack of self worth, even suicide, are benchmark symptoms.

(3) Lack of education: Plan managers cannot simply provide plan members with a carrier web address and expect them to study the importance of taking their prescribed medications. Rx therapy compliance must be a central point with respect to wellness programs and other population based health education. Here’s an example of workforce perceptions concerning blood pressure medications. Today physicians have a large group of antihypertensive drug classes to help patients control blood pressure. One type, Beta Blockers, are sometimes contraindicated for men concerning sexual performance. Absent any clinical education, imagine the impact of one police officer’s story concerning “this” performance could have on 100s of male police officer’s adherence Rx therapy for any blood pressure class? Locker room discussions are the “grape-vine” of many employer organizations. The “grape-vine” should not be the information super-highway of critical health information to your employees!

Plan manager’s–part of  “taking your medicine” is to determine critical Rx compliance ratios for your own plans. The data are available. Don’t let anyone keep it from you!

Frightening WSJ article-2/28/11– February 28, 2011

Posted by medvision in Cancer Care, Chronic Disease, Employee Wellness, health data, Healthcare Costs, Uncategorized.
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“The FDA and Slower Cures: The bureaucratic assault on cancer treatments.”



We know our plan’s are being swamped with expensive, unnecessary back surgeries, what about invasive heart surgery? February 19, 2011

Posted by medvision in Chronic Disease, Employee Wellness, health data, Healthcare Costs, Insurance Plans, Rx Costs, Uncategorized.
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Every minute of our lives a systemic microscopic battle rages within our body between free radicals and antioxidants. The macro outcomes of this 24/7 battle leads to disease or good-health. Dr. Michael Ozner, author the “Great American Heart Hoax” conducted this interesting interview with “Reach MD”. He exhibits strong evidence-based connections between wellness activities, good diet and stress control to the absence of serious disease.

Too bad our “mislabeled” healthcare system actually is a focus upon disease care. We spend 95% + of all assets on already manifested disease, and by investment percentage, we ridicule disease prevention.

Cancer–Navigations of a caregiver March 23, 2010

Posted by medvision in Cancer Care, Chronic Disease.
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Three of the most devastating words in the world, “you have cancer.”  Most of us know of someone close facing cancer, many will become the caregiver for a cancer patient and some will face this disease personally. Years prior, my Mom had been diagnosed and treated for breast cancer. My family had always considered her a breast cancer survivor. So, 3 years ago, I was rattled to stark reality when my brother called saying, “the doc thinks Mom may have bone cancer.”

To back up, I’d been living in Florida for 20 years, and Mom lived, alone, in Tennessee. I’d been working providing health risk/quality management consulting services for mid to large employers,sponsoring self-funded medical benefit plans. I remember thinking, we’ll take things one day at a time, and I should have a “leg up” helping her manage her disease/process. I traveled to Tennessee and moved into my Mom’s house. (I already thought I was at a huge advantage as I could live with my Mom, work via WebEx and call on my brother’s assistance if I had any business travel)

By the time I arrived and unpacked, my Mom had already decided to go with a therapy the oncologist recommended, Gemzar. She remembered this will be relatively mild as it leaves hair intact.  Gemzar (Gemcitabine HCL) is a chemotherapy treatment which attempts to disable/slow/destroy cancerous tumors by a poisoning with a chemical compound. Maybe this was the mildest stuff available. After 3 weeks on therapy, we jointly decided to withdraw as her health was suffering to the extent I was worried she couldn’t survive. It took 3 additional weeks for her to recover to a state of what I considered normal. 

(Vital learning experience)–Other than providing emotional support and transportation, I’d flunked my introduction to caregiving. I failed to study, inquire about the side effects of Gemzar, or even question the physician’s treatment why he’d prescribed the drug. As important as the question of why, I’d missed the next question: “What happens if she decides not to take Gemzar”? Cancer is like no other disease. By its very definition, it tends to defy logic and reacts poorly to concepts we think of as evidence based treatment. By Mom’s next visit, I was armed (I thought) with insightful questions and suggestions. Prior to walking into his office, I picked up a cancer glossary similar to the one here. http://www.cancerindex.org/glossary.htm I had not scratched the surface!

Who’s buried in Grant’s tomb? March 1, 2010

Posted by medvision in Chronic Disease.
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Ulysses Grant? An old mind puzzle.

I feel the same reaction each time I see another article written in the national press asking, “why are healthcare costs rising so rapidly?” The answers given are amazing. Some experts point to technology… or it’s too easy to see the doctor…or we don’t understand the components of healthcare costs.

Our Centers for Disease Control and Prevention state 75% of our national healthcare expenditures are utilized to treat chronic disease. This does make sense as healthy people don’t seem to utilize intensive hospital-based care systems or utilize expensive drugs. So, yes, the answer is our healthcare inflation is due to increasing rates of population-based chronic disease.

Chronic disease is the cause of inflation in public plans, Medicare/Medicaid and employer-provided clients, whether self-funded or fully insured. This subject needs to be the focus of every discussion concerning healthcare. Yes, we do need to become better consumers of healthcare, and I agree, certain individuals do over utilize services.

Here’s a truism which encompasses my entire client base. When physician provided screenings increase, and employers focus on member-driven wellness strategies, the cost per member per month decreases. Physician directed/reinforced diet, exercise and pharmacologic therapy prevents catastrophic medical events.

Disease Management–GE “Sounded too good to be true–it is” February 6, 2010

Posted by medvision in Chronic Disease.
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BusinessWeek leads with a controversial subject, disease management results, in this week’s edition. It’s a subject on which entire books are written, $100s of millions spent and yet leaves many health plan managers, scratching their heads.

“Should we spend the additional $5 per employee per month for disease management this year or not?”

Here we go, let’s try and apply some logic. First, how much do we think GE spends for healthcare annually, per employee? I’ll take a wild guess, let’s say $8000. In reality, the $8000 average is heavily influenced by the claims of the top 5%, as the bottom 85% probably average incurring less than $700 per year. The annual claims, of the top 5% health plan members equal 60%+ of total annual expenditures. The numbers work like this: top 5% account for 60% of plan assets, bottom 85% less han 25%. 

Wait a minute, $5 per employee per month/$60 per year? In other words, to mitigate disease, plan sponsors invest .75% of the employee’s average annual healthcare cost? That’s right, $60 per $8000. And here’s the great part of the process: Possibly, employees, and/or covered dependents, could get a phone call from an unknown nurse, many states away, questioning the individual’s health status and or disease? Many times this nurse might even know two of the three diseases diagnosed and if a prescription was refilled last month. Of course this call may come during a very convenient time, dinnertime or maybe Saturday morning.

What’s amazing is employer plan sponsors think this could work in the first place? Again, investing $.75 for each hundred dollars of disease cost, or $.75 invested in prevention and disease mitigation (less than 1%). How many nurses get assigned for that $.75 investment? Maybe one per 20,000 members?

Here’s the deal. The health of American workers is important to productivity, very complex and changing rapidly. We are facing  continuous stress over our jobs and families, sometimes declining health, increasing cost for healthcare and 8 minute doctor visits. And, now to help us out, we get a website address and maybe a phone call from a nurse in New Mexico. This can best be described as “the dog won’t hunt”.

So what works while being cost effective? A wise person once said, ” Healthcare is a local thing”. It really is. My clients, following many pioneering, caring employers are bringing health services on the job site. On-site nurses and wellness clinics all the way to full service on-site physician offices. It’s merely risk-management in a caring manner. Oh yeah, the ROIs being derived are terrific.

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