The ACC and Philips: Common-Sense Collaboration

Anyone paying objective attention to what the new healthcare legislation has spawned has noticed creative juices beginning to ooze out here and there. To wit: Royal Philips Electronics and its from-hospital-to-home heart patient monitoring technology collection. Two desired endpoints here: Saving lives and saving money.


Next year – if the healthcare legislation stays intact – hospitals that have an inordinate amount of readmissions for heart failure, MI or pneumonia will start losing Medicare reimbursement. Year one: 1%, year two, 2%, year 3, 3%. After that, the list of readmitted conditions grows that can produce a penalty. Medicare has been paying big-time for unplanned hospital readmissions, according to a study in the New England Journal of Medicine: $17.4 billion in 2004.


Philips unveiled its tech collection at the recent American College of Cardiology conference; the ACC is one of its partners in this endeavor. No doubt critics of physician-industry collaboration will be screaming while reading this – but how else are cardiologists supposed to learn about these products?


The products include bedside monitors with early warning systems; a cable-free progressive care monitoring system; home tele-health system; and a remote cardiac service with diagnostic arrhythmia monitoring and additional patient self-testing.


It’s all about connecting the dots: giving cardiologists insight into how their patients fare when they get home.


But it's also about patient education and better communication among patients and providers along the healthcare continuum – make no mistake, it will always be about these two. We doubt this country would be facing this healthcare debacle if we had a handle on the first issue and had never sacrificed the second. 

$4 Generics and Medication Non-Adherence

Let’s face it – the business of healthcare is enough to make anybody nuts.

Take the recent study, conducted in 2007, showing only a handful of people, relatively speaking, who took advantage of their healthcare insurance provision to buy $4 generic drugs. If all the people who could buy $4 generics did so at that time, society would have saved nearly $6 billion. A lot of money, no question. The study included 31,000 people; fewer than 6% bought $4 drugs.

It’s tough to imagine that 93% of these people hated society, so maybe there’s something else going on here. They didn’t know? Perhaps. They don’t like generics? Unlikely. According to the Kaiser Family Foundation, 72% of all scripts written in 2008 were generics, and sales of generics grew 8% from 2005 to 2006. The percentages wouldn’t have changed that much from 2007.

In that same study, “Over half of physicians say they frequently talk with patients about the out of-pocket costs of medicines they prescribe, 62% say they switch patients to less expensive drugs, and 58% say they give patients office samples.”

It's anybody guess why those patients chose to spend more money. But, none of the above is the good-grief part. The following is.

Back in November, the New England Journal of Medicine ran a piece about the possible damage that these $4 generic sales can do to long-term improvements in healthcare.

Normally, when a patient purchases a prescription with insurance, that purchase generates a claims record. The pharmacy sends the claim to the pharmacy benefit manager. These claims can be used for healthcare management, including medication safety, verifying clinical trial results, and ensuring medication adherence.

But, with the $4 generics, patients often pay in cash. The authors say the pharmacies often do not submit the claim information “since they have no incentive to do so.” The result: patients are classified as non-adherent or non-users. And, because these drugs are often prescribed for chronic diseases, “the consequences of these missing claims are not insignificant.” This is also important to the topic of medication adherence because it already suffers from a lack of awareness. With almost 80% of the prescriptions today being dispensed as generic, medication non-adherence will become more of a silent disease.

The authors, Niteesh K. Choudhry, M.D., Ph.D., and William H. Shrank, M.D., M.S.H.S., aren’t labeling the pharmacies as bad guys – their actions are unintentional, they say. But, as they point out, new systems need to be devised to make sure the claims are filed. 

ACOs and Fierce Communication

So here’s a question to ponder while you’re reading our carefully honed prose: How do you attract patients to sign up for an accountable care organization?

Last week, Cigna announced that its two ACO pilots were doing, at least preliminarily, what they should be doing: improving patients’ health and saving money. The giant insurer is so happy with the results that it is planning a national expansion of its ACO program this year.

Here’s why they’re happy: At its multi-specialty medical group practice division in Phoenix, the average annual savings per patient was $336; ambulatory surgery was down 11%; preventive care visits, overall, were up 3%, and up 12% for adults. And, its partner in New Hampshire is “closing gaps in care 10% better than the market.”

A few years ago, Cigna jumped on the ACO bandwagon. The goal: “Achieve the ‘triple aim’ of improved quality, lower medical costs and improved patient satisfaction by creating a care model anchored in the principles of the patient-centered medical home that also builds in accountability by rewarding physicians for results.”

In its press release Cigna says its collaborative ACO model is big on communication. Its doctors and nurses speak frequently with its customers’ doctors and nurses, “to help with coordination of patient care.” Cigna’s program also includes disease management programs and lifestyle management programs, including stress management.

Cigna doesn’t say how its customers reacted to the idea of participating in an ACO. That notion is even more interesting for Medicare patients. How will Medicare—by law, mandated to start pilot programs by next January—attract its seniors, normally an independent, privacy-loving lot? According to the new healthcare law, the pilot ACOs will take care of all the healthcare needs of at least 5,000 Medicare patients for three years, minimum.

FierceHealthcare says the success of these ACOS will require “fierce communication strategies,” like physicians doing things they don’t normally get paid for—contacting patients by e-mail, instant messaging and so on.

But as usual, it comes down to communication. We somehow doubt that it will matter what the medium is: word of mouth, Twitter, radio, smoke signal. If the ACO healthcare providers are communicating among themselves, sharing information about a patient’s well-being, and that patient’s health is improving, along with his quality of life, then that patient will spread the word.

And that can be pretty fierce, don’t you think?

Patience and Effective Disease Management Programs

The McKinsey Quarterly recently did its usual fine job, explaining in detail how other countries are running effective disease management programs. McKinsey says a successful disease management program has these common denominators: many participants; simple rules to follow; is patient-focused; has clearly defined measures; and aligned incentives. Sounds doable, right?


And then it got to the kicker.

“Any group thinking of sponsoring a disease management program must also realize that a large program takes years, not months, to get completely off the ground. It took Germany more than six years to fully implement its program for type 2 diabetes.”

Kind of dooms the notion of a successful disease management program happening in this country. Americans are not exactly the most patient of people.

Need proof? In a survey published Jan. 21, 2009, 79% of Americans were “optimistic” about this country’s future under the leadership of its new president, Barack Obama. By July 30, 53% said they didn’t like how Mr. Obama was handling the economy. Four months later, his job approval rating had fallen below 50%.

If we’d gain a little patience and let providers develop some effective disease management programs, can you imagine what the savings to lives and the bottom line would be? Isn’t that worth a little patience?

Maybe if we thought of a disease management program as a bottle of fine wine, aging to a perfect maturity....