The Truven Health Blog

The latest healthcare topics from a trusted, proven, and unbiased source.

How Strong is the Physician-Patient Bond?

By Michael R. Udwin/Thursday, October 31, 2013
Michael R. Udwin imageThe Wall Street Journal article “Comparison Shopping for Knee Surgery” chronicles a successful California Public Employees' Retirement System (CalPERS) pilot, which established a $30,000 “reference price” for hip and knee replacement procedures. Under this scenario, patients were free to pursue surgery at a hospital with pricing above this threshold but would be responsible for the excess cost. As anticipated, patients preferentially selected facilities with pricing at or below $30,000, while many hospitals with pricing above $30,000 reduced fees to mitigate declines in patient volume. Interestingly, this behavior contradicts the axiom: “patients choose the doctor not the hospital.”

This is not the first time we have witnessed fraying in the physician-patient bond. Routinely, outpatient respiratory complaints are encouraged to visit an urgent care center rather than the family practitioner. And the days where the office internist also managed inpatient pneumonia care are long gone, as hospitalists now attend to a large portion of admissions.

CalPERS benefited from an innovative pricing structure designed to selectively encourage high-quality, lower-cost surgical settings. Such an outcome is certainly no surprise to anyone navigating a world of increasing co-payments and deductibles. Beside monetary considerations, are there other factors contributing to physician selection and retention? Of course, word of mouth, referrals, and accessibility are relevant. With enhanced transparency, perhaps quality and patient satisfaction scores will emerge as strong motivators.

The question still remains: “how strong is the physician-patient bond?” Sentimentally, I would like to believe that personal connectedness and longevity determine the strength of cohesion. Yet realistically, perhaps I should be content with the knowledge that if not now, then soon, patients will choose their doctor based on adherence to best practice, outstanding clinical outcomes and appropriate use of resources…and a great personality!

Michael R. Udwin, MD, FACOG
National Medical Director

Patient Activation Matters! Does Your Patient Health Education Solution Engage and Activate?

By Heather Du Mez/Wednesday, October 30, 2013
Heather Du Mez imageWith the proliferation of patient health education solutions designed to take patient engagement to the next level, how can you ensure the solution you choose engages your patients and increases their “activation?” Do your patients understand their role in the care process, including the knowledge, skills, and confidence to take on that role?

Research continues to demonstrate that highly activated patients are more likely to have better outcomes:
  • Highly activated patients have lower healthcare costs (1)
  • Patients with higher activation levels are more likely to have normal systolic blood pressure, triglyceride and HDL levels, a healthy weight, and less likely to visit the emergency room or become hospitalized (2)
  • Highly activated patients have more positive care experiences (3)   
At Truven Health Micromedex® Solutions, our collective experience of providing patient education solutions to thousands of hospitals world-wide, has resulted in evidence-based patient health education content that is designed to engage and activate. The content, found in our Micromedex® CareNotes® Solution, adheres to health-literacy standards (written at a 5th-to-7th grade reading level, in plain, easy-to-understand language) and  leverages ADDS (actionable, direct, directive, streamlined) design principles. CareNotes are:
  • Actionable. Instructions emphasize how to complete a task, including crucial details and steps describing the behavior a patient must change, or the actions a patient must perform. 
  • Direct. State information directly and concisely. The message is not complicated with extra words or unnecessary medical terms. 
  • Directive. Tell the patient what to do and what not to do, so the patient is not left to guess whether directions are necessary or merely suggested.
  • Streamlined. Remove information that is not necessary in order to highlight need-to-know information.
This approach is responsive to the research around activation and best represents the needs of our customers to keep their patients actively engaged in their own health care.

What innovations is your hospital or staff making to promote activation and to ensure the patient experience is interactive? What do you think are the most critical imperatives for activation improvement? Post a reply and share your ideas. Sharing our collective experiences is a great way to learn what is and is not working among your peers.

Learn more about how our comprehensive editorial process and procedures promote patient activation to improve health literacy, motivate patient behavior, and increase compliance.

Heather Du Mez, RN, BSN
Editorial Manager

What Do Hospitals Do When Medicare Cuts Hospital Prices?

By Tracy Yee/Monday, October 28, 2013
Tracy Yee imageOne of the key provisions in the Affordable Care Act (ACA) permanently lowers the default rate of growth in Medicare prices for hospitals and most other providers by applying a downward adjustment each year equal to the growth in the economy. The Congressional Budget Office estimates that policy change will reduce Medicare expenditures by $379 million from 2012 through 2021. Researchers and policymakers have theorized that this approach may lead hospitals to try to recoup their anticipated losses in a number of ways—one of which would be increasing inpatient hospitalizations in an attempt to “make it up on volume.”

To test this theory, Chapin White, a senior researcher at the Center for Studying Health System Change, and I recently completed analyses to examine whether changes in Medicare prices were associated with changes in Medicare inpatient patient volume. We examined the relationship between market-level price trends and trends in the number of inpatient hospital discharges among the elderly (65+ years of age) across 10 states over a 15 year period (1995-2009).

Overall, we observed that by 2009, inpatient hospital stays were much shorter and patients received much more intensive treatment. Taking a closer look, we found that hospital markets with lower growth in Medicare prices had smaller increases in hospital utilization and greater decreases in length of stay compared to markets with higher growth in Medicare prices. These results suggest that Medicare price cuts lead hospitals to reduce capacity and provide fewer services to the elderly. When we simulated the effect of a 10 percent decrease in the Medicare price, we found that discharges of elderly patients decreased by 4.6 percent and the number of hospital staffed beds decreased by 6.3 percent.

Our findings run counter to the notion that hospitals will attempt to recoup losses from Medicare price cuts by increasing inpatient volume. Rather than leave beds empty, hospitals appear to constrain their scale of operations. In this way, hospitals appear to behave as profit-maximizing firms that increase output when they are paid higher prices and decrease output when the costs of production rise. Considered in the context of the ACA price cuts, findings suggest that Medicare savings may actually be larger than expected due to hospitals volume response. Conversely, if the Medicare provisions in the law were repealed, Medicare spending might increase by more than has been projected. Our findings also point to important questions for future research – in particular, examining the impact of Medicare price reductions on the quality of care beneficiaries receive, as well as their overall health outcomes.

Tracy Yee
Research Leader
Behavioral Health and Quality Research Division

Can Personalized Healthcare Communications Really Drive Behavior? Yes, and Here’s How.

By Matthew Collins/Friday, October 18, 2013
Matt Collins imageAsk any healthcare consumer, and there’s a 50-50 chance that they have little idea, without a call to their doctor, when they should have specific, preventive cancer screenings based on their age, or what their target cholesterol levels should be for their specific health history, or what happens if they don’t take their blood pressure medication every day.

In fact, recent studies by Truven Health Analytics experts found that at least half of healthcare consumers don’t get the care they need (as recommended by evidence-based guidelines) and up to 50 percent don’t take medication as prescribed. That lack of knowledge is translating into higher healthcare costs for employers and health plans, which trickle down to the consumer in a time when everyone’s worried about rising healthcare costs.

There is good news, though, and it comes in the form of highly personalized healthcare communications.

More and more studies, including one published in the Journal of Public Policy and Marketing, prove that engaging people with tailored, timely, and relevant messages about their health improvement opportunities can increase care compliance by 10 to 20 percent. That type of boost can save employers, health plans, and consumers significant amounts of money, thanks to early identification and cost avoidance.

When we talk about cutting-edge, customized healthcare messaging that produces results in the real world, it goes well beyond the “it’s time to think about a mammogram” to “it’s been two years since your last mammogram, and here’s why that’s especially dangerous for you, and we know you don’t want to put your family at risk, and here’s how to act on this information in the easiest and most cost-effective way possible.”

The foundation of that type of detailed communication is the use of targeted data, analytics, and market segmentation. Those elements must continually inform not only the basic message content, but also the tone, emotion, and other tactics.

A recently published Truven Health insights brief, Four Steps to Creating Healthcare Communications That Drive Behavior Change, discusses how to accomplish this by basing communications on a consumer-specific profile, using eligibility, medical claims, and other available data. Data might include age, gender, ethnicity, family structure, and medical and drug history. The next step is to assign each individual to a refined demographic, psychographic, and behavioral segment, so that tactics, images, emotion-level, and preferred communications channel can be versioned by what they prefer and how they tend to react and behave when it comes to healthcare decisions.

This process has been delivering an ROI of 3:1 or higher in many cases — a boon for helping employers and health plans achieve financial stability when trends continue to consistently increase. The best part, of course, is that consumers benefit, as well.

Full Personalized Healthcare Messaging Brief Available
Download the complete brief, Four Steps to Creating Healthcare Communications that Drive Behavior Change.

Matthew Collins
Director of Product Management

Paying for Volume, Paying for Value – How About Paying for What Works?

By Michael L. Taylor/Tuesday, October 15, 2013
Mike Taylor imageHealthcare costs consume nearly 18% of the U.S. GDP, twice the percent of any other country in the world. In a study recently released by Truven Health Analytics, healthcare costs incurred by employers have risen by 4.3% annually since 2006. Much of that increase occurred in hospital outpatient services, growing at an annual rate of 6.5%; pharmacy costs grew only by 2.1% annually. The rate of rise has attenuated over the last several years, probably mainly due to the recent recession. As the U.S. economy recovers, one can expect healthcare cost inflation to rise again.

Clearly healthcare costs are a major issue in the U.S., and a solution must be found. In the past, employers used many approaches to control the healthcare spend. Disease management programs, health coaches, and raising co-pays and deductibles have all been tried, but these efforts have not been very successful. A large part of the problem is the way we pay for healthcare in this country. “Fee-for-service” payment rewards doctors and hospitals on the basis of the quantity of services provided. This payment method is an incentive to provide more services, with no emphasis on the quality or outcome of those services. Unfortunately we know that many of those services have no useful purpose: earlier Truven Health studies have found nearly $3.6 trillion of wasteful spending over a ten year period. New technology and the rapidly growing market of biologic drugs will continue to drive costs higher, but misuse and overuse of these technologies and drugs needs to be controlled. It’s been said that the most expensive piece of equipment in a doctor’s bag is the pen, and that is still true today.

The Affordable Care Act offers a potential solution by incenting organizations to improve the overall appropriateness of care provided to patients. Incenting higher quality of care, rather than higher volume of care, will help control healthcare cost inflation. Strategies such as bundled payments encourage more efficient use of healthcare resources, and the development of Accountable Care Organizations (ACOs) will hopefully change the way medicine is practiced in the U.S. In the ACO model, overuse of technologies becomes a cost issue, not a profit center. In an ACO environment, a hospital or health system is incented to provide more cost effective care; there are no such incentives in a fee-for-service environment. 

New advances in medicine need to improve the care we receive, but we should not adopt new technologies until they have been proven to be effective. The Mayo Clinic Proceedings recently published a list of 146 common therapies that have been shown to either not work or cause harm. For example, stem cell transplant for breast cancer was widely adopted in the late 1990s, but was later shown to not be effective. Knee lavage for osteoarthritis has been performed on thousands of patients, but we know it isn't beneficial. We should not and simply cannot afford to pay for treatments that don’t work.

Michael L. Taylor, MD FACP
Chief Medical Officer