The Truven Health Blog

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

Are Doctors Learning From Hospitals?

By Michael R. Udwin/Wednesday, July 31, 2013
Michael R. Udwin imageAs suggested in the recent article from Kaiser Health News, in collaboration with The Washington Post, “Medicare Announces Plans To Accelerate Linking Doctor Pay To Quality,” physicians will soon be confronted with a reality that hospitals have already experienced. With reimbursement currently at risk for readmissions, perhaps doctors can learn from hospitals as they adjust to a new world.

Hospital reactions to pay for performance have varied dramatically, from denial to indifference to dread. Those that have fared best recognized the importance of data and understanding their unique position within the care continuum. They began by asking the right questions. If heart failure readmissions were too high, they posited the “why.”  They were not afraid to pursue the follow-up questions, including “What populations are at higher risk?”, “Is this related to process or provider-related?” and “What needs to change within our control and outside our walls?”

Although doctors often pride themselves on the desire to deliver top quality care, in the office much of the focus for many has been on establishing an efficient, sustainable practice. Through hospital employment and other alignment strategies, physicians of late have begun to view their role as team member within an organization. As co-management of patients takes hold and process measures begin to meld with outcomes, this team approach will become even more important.

For some this will be a new way of viewing performance in the outpatient space.  Quality does count, as suggested in the article. And now more than ever, doctors can learn from hospitals, as they leverage data and ask the right questions to ensure the best for their patients.

Michael R. Udwin, MD, FACOG
National Medical Director

Rate Setting by Insurance and Exchanges

By Anita Nair Hartman/Wednesday, July 31, 2013
Anita Nair-Hartman imageAs the October 2013 open enrollment date for insurance marketplaces approaches, more information is emerging on how states are managing the premium rates set by health insurers. Maryland is an example. As a recent Washington Post article noted, this state is working diligently to ensure affordability for consumers in its market.

Questions remain: How easily does the open enrollment work for consumers? And are states or the federal government able to support consumers as they navigate the healthcare maze and try to understand their out-of-pocket costs and assess the best plans for their situation? Consumer understanding of plan design options and their associated costs, as well as their subsidies, will be the ultimate test of the work states and federal government did to keep rates low. We’ll know in October whether consumers were adequately supported

Anita Nair-Hartman
Vice President Market Planning and Strategy

Good Intentions Gone Awry: Solving for the Prescription Pain Medication Epidemic

By Tami Mark/Monday, July 29, 2013
Tami Mark imageHeroin in New England, More Abundant and Deadly” headlined an article in the July 18 edition of The New York Times that described the alarming comeback that heroin is making across the quaint towns and larger cities in New England.  Behind the growth in heroin use is a sad story of good intentions gone awry. A push to better treat patients’ pain and the introduction of oxycodone, a powerful and highly addictive pain medication, resulted in today’s massive prescription pain medication epidemic. The CDC recently reported that more people are dying from overdoses from pain medication than car accidents.

Efforts to clamp down on pain medication misuse have created the unfortunate consequence of, in effect, encouraging people with opioid addictions to substitute heroin for prescription pain medication. How can the healthcare system avoid this continuing cascade of unintended consequences? A key step is to ensure that individuals have access to a robust addiction treatment system. This effort can be enhanced with coordinated use of data and analytics.

Medicaid programs, for example, have established prescription drug monitoring to identify individuals who are abusing prescription drugs. However, such efforts need to be coupled with access to a robust substance abuse treatment system that includes access to the most effective medications for the treatment of opioid addiction – Suboxone® (buprenorphine/naloxone) and methadone, as well as coordinated substance abuse outpatient, inpatient, and rehabilitative services. A number of state Medicaid programs do not provide coverage of methadone treatment and many have time limits on the use of Suboxone. Analysis of de-identified Medicaid prescription and medical claims data, substance abuse treatment data, and prescription drug monitoring data can help states determine whether their systems are not only reducing misuse and diversion of prescription drugs, but are also providing access to high-quality addiction treatment that will keep their populations from substituting heroin use for pain medications that they can no longer obtain.

The total U.S. societal costs of prescription opioid abuse was recently estimated at $55.7 billion in 2009 - more than double the $24 billion that was spent on all of substance abuse treatment in 2009* as reported by Truven Health Analytics in Health Affairs. Thus, the numbers suggest greater coordination will have an economic, as well as a public health payoff.

Tami L. Mark, PhD
Vice President, Behavioral Health and Quality Research

A Higher Level of Patient Experience

By Michael R. Udwin/Thursday, July 25, 2013
Michael R. Udwin imageThe recent Los Angeles Times article “Healthcare Overhaul Leads Hospitals to Focus on Patient Satisfaction” offers a positive glimpse into a future where patient quality and satisfaction need not be two distinct entities. In this paradigm, it’s no longer enough to merely provide a diagnosis, therapy, or procedure. The experience is integrally related to outcome.

Ask anyone who has walked into a Starbucks if atmosphere matters. Yes, the $5.00 cup of coffee is tasty, but the friendly cashier, the barista, the deep leather chairs, and of course the Wi-fi, are all part of the experience. Yes, the coffee itself matters. But so does everything around that cup. The same holds true for the hip procedure. Yes, you expect not to die during the procedure or have a complication. But now more than ever, you hope the staff is friendly, the admission and discharge process is smooth, and your medicine and other ancillary services are provided in a timely and efficient manner.

Recently, I visited a hospital where they had just begun handing out physician business cards with a picture of the doctor on the front. These cards were intended to improve patient familiarity with the multitude of providers involved in each admission. For some doctors, the initial reaction was one of disgust. “This is unprofessional” and “What's next, commercials and phone book advertisements?” were common refrains expressed shortly afterwards. Yet, why should doctors not be proud of the experience they provide?

As doctors embrace this new level of accountability and distinction, the processes that support that level of experience will be extremely important. As patients reflect on the care provided, it will be difficult to separate the doctor from the pain they experienced, and to that end, how quickly it was relieved by a friendly, efficient staff.  As members of a broad hospital community, doctors can play a vital role to ensure that quality is more than just an outcome, but instead a higher level of experience.

Michael R. Udwin, MD, FACOG
National Medical Director

Health Plan Support of the Newly Insured

By Anita Nair Hartman/Wednesday, July 24, 2013
Anita Nair-Hartman imageA recent Kaiser Health article discusses the premiums consumers will face in the new public exchanges. There has been much market focus and press on the rates that consumers will be charged and the potential impact to enrollment. Although this is an important topic, equal attention should be focused how we will manage these newly-insured consumers. From research that Truven Health completed earlier this year titled, Coverage Expansion Under the ACA: Challenges for Government, Health Plans, and Providers, we know that there is limited information in the market on this subset of consumers.

Our research indicates that these newly insured will be less healthy, currently use services at a lower rate, and have gone long periods without coverage due to insurance cost. All of this research suggests that the newly insured will most likely have service needs that they have deferred and will present challenges for the health plans who cover them. It will be critical that health plans support these new consumers with tools and services to help them understand and navigate their new health care coverage. As we have noted in the past, consumers who have more information are able to make wiser decisions about their healthcare choices. And this leads to improved quality, lower costs, and higher satisfaction with their health plan and exchange.

Anita Nair-Hartman
Vice President, Market Planning and Strategy