The Truven Health Blog

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

Is Obesity a Disease or a Risk Factor?

By Ray Fabius/Monday, February 11, 2013
Ray Fabius imageHaving family members who are struggling to control their waistline, I am sympathetic to the issue of weight discrimination. But the Obesity Epidemic is a threat to our nation's health and budget. Studies suggest that it may even be causing a reduction in average life expectancy for the first time in over a century.
The question is not whether to call obesity a medical problem but rather whether to call it a disease itself, instead of just a risk factor. It is so closely tied to type II diabetes, heart disease and musculo-skeletal conditions and its is so difficult to correct once established that many experts are beginning to view obesity, particularly morbid obesity, as a chronic disease. Perhaps being overweight is a risk factor but at the point where someone reaches BMIs over 30 or 35 we should provide greater medical resources and contend with this as a recognized disease. And perhaps we need to address the segment of the population that is not obese and prevent them from unhealthy weight gain. To accomplish this will require cultural change. We can either soften our concerns about this great threat or get moving to reduce it.

Ray Fabius MD
Chief Medical Officer

Transparency + Accountability

By Ray Fabius/Friday, February 8, 2013
Ray Fabius imageI celebrate the efforts of the state of Massachusetts to advance price transparency within health care. With the wide variety of health plan alternatives and benefit designs it has never been easy for consumers to estimate what their out of pocket costs will be before accessing elective care. In many, maybe most cases, the information is not available.

Truven Health data analysis has shown wide and unexplained variation in the cost of the same service within metropolitan service areas - sometimes this variation can be three fold or more, and patients are generally unaware of this. Providing online tools to disclose a price is a good start. Enhancing these tools to allow for price comparisons is the next step. Studies show that tools like our Treatment Cost Calculator have the potential to significantly reduce total health care costs for employers by providing their workers the ability to compare prices.

The ultimate goal should be to offer the patient quality assessments as well as cost comparisons so consumers can select their providers based on value. Then the burden for better outcomes of care shifts at least in part to the consumer who needs to be accountable for evaluating the information available and making the best choice. If they exercise this ability, health care delivery will need to respond with a more healthy marketplace competition previously not seen in the medical industry. Providers will need to pursue the most efficient and effective pathways to attract patients and keep them.

Price transparency is an important step in this necessary direction.
Ray Fabius MD
Chief Medical Officer

Falling Down on the Job Starts by Getting Up

By Ray Fabius/Thursday, February 7, 2013
Ray Fabius imageWhile the early efforts to promote movement while working appear to be imperfect, the pursuit is laudable. Most disturbing is recent evidence that sedentary lifestyles are an independent risk factor, even for people who exercise regularly. Sitting uninterrupted for more than four hours a day is unhealthy. I know that many of my colleagues here at Truven Health are at their desks for four, five, six hours straight, every day, and I’m trying to change that.

At a minimum, regardless of their specific work content, office workers should be encouraged to get out of their seats frequently and walk around for a few minutes. The challenge for companies trying to promote simultaneous exercise and work is our own limitations on multi-tasking. It’s possible that typing and walking in place is simply a too-difficult combination of activities; perhaps the use of treadmills and elliptical trainers should be limited to conference calls. In the end it remains true that a healthy workforce is a competitive advantage and hard working employees who never leave their workstation may not be the best performers over time.
Ray Fabius MD
Chief Medical Officer

Hospital Readmission: A Marker for Better Transitions of Care

By Ray Fabius/Wednesday, January 30, 2013
Ray Fabius imageThe Medicare penalty is causing hospital systems to pay greater attention to complex patients who are at risk of re-admission.  As one who has focused a tremendous amount of time and energy on population health issues, I can tell you this more intense focus is a great step forward.  To execute this Medicare penalty with fairness, the severity of the population served needs to be considered.  Fortunately, organizations like Truven Health Analytics have developed tools to adjust for the illness burden of the patients treated and can evaluate actual performance against what should occur or can be predicted.  By doing this adjustment, hospitals that treat the poorest and sickest people should not be unfairly penalized.  And no institution or doctor should feel pressured to not re-admit someone in need.

From a population health standpoint, a hospital admission identifies someone in the community who needs more health care and support.  A re-admission is even a greater indication.  Our country cannot have a health care system where nearly 20% of its senior citizens who are hospitalized, return for re-admission within 30 days.  It demonstrates a need for our delivery system to adjust, and transitions of care are an obvious focus for change. 

Most often the physicians and other providers who care for a patient inside the hospital are not the same as those who take over outside the hospital.  The handoff between them needs to be coordinated better, with more complete information integrated in the process. Often as well, the patient has limited resources – physical or financial – to assist in their recovery.  The hospitalization itself, particularly for the elderly, is debilitating.  In some cases, skilled nursing facilities and rehabilitation units need to be better leveraged.  Certainly home care services for many of these vulnerable patients needs to be deployed.  By focusing on a more comprehensive transition of care process for their patients who are most at risk for readmission, hospitals can reduce readmissions and at the same time provide appropriate support for their communities of patients and providers.

Ray Fabius MD
Chief Medical Officer

Funding for Health Insurance Exchanges - Just One Step Toward Better Care

By Ray Fabius/Monday, January 28, 2013
Ray Fabius imageHealth Insurance Exchanges are an important next step required under the ACA. These virtual marketplaces will provide individuals an opportunity to "shop" for the best coverage for their dollar spent. Theoretically, enough buyers will purchase policies through these exchanges that price competition will prevail and health insurance for individuals will be more affordable than it is today.

With affordable options, the individual mandate requiring coverage, and the expansion of Medicaid for low wage earners, our country can approach near universal access to healthcare. Next we must create a health care system with a strong primary care base to support this transition in coverage. The promise of care improvement and care efficiencies is based not only on coverage of all but also timely access to care.

Ray Fabius MD
Chief Medical Officer