Health Management

Stakeholders must influence individuals to become more responsible for their choices.

A tobacco cessation benefit can reduce future medical costs.

Chronic care patients need reminder calls to remain adherent to treatment and show up for appointments

Pre-empt the pitfalls of self-diagnosis with an employer-branded health portal.

Heart disease is considered the costliest condition, outranking cancer. Some 80 million people require care for coronary heart disease

Some employers might need to adjust copay structures overall to achieve adequate compliance.

Hypertension is the leading medical condition, and health plans are finding better ways to increase DM program participation rates, such as Aetna's program tailored to the African American population

The disabled, elderly and poor populations would benefit from Medicare / Medicaid integration, but barriers have yet to give way

A recent study by the University of Connecticut indicates that the cost of low health literacy to the U.S. economy is as high as $238 billion annually. It's imperative that health plans and systems drive new efforts.

Disease registries are gaining in popularity as electronic tools designed to give physicians clinical support to deliver appropriate care.

The continual inability to fall asleep or stay asleep is keeping approximately one-third of the nation up at night. Individuals with insomnia incur $12 billion in direct medical costs and $2 billion in drug costs alone.

Methicillin-resistant Staphylococcus aureus (MRSA), a type of bacterium that is resistant to certain antibiotics, has become a national epidemic, with increasing numbers of serious infections, hospitalizations and deaths. Hospital stays for these infections tripled from 2000 to 2005.

The convergence of rising healthcare costs, increased cost sharing and demand by consumers for more participation in healthcare decisions is producing a variety of innovative health insurance solutions.

The practice of shared decision making (SDM)-the collaboration between patients and caregivers to arrive at an informed, value-based healthcare decision when treatment options have features that patients value differently-is gaining recognition among health plans as a key function of a patient-centric model of care.

An increasing number of studies are linking oral health to general health. While not establishing a direct cause-and-effect, the reports show that early prevention and treatment of gum disease could improve outcomes for pregnancy, heart disease and diabetes.

Although prevention has become a key element in traditional disease management programs-trying to prevent or mitigate a chronic disease before it exacerbates-that may not be sufficient when a patient has a late-stage or end-of-life condition. There is a new emphasis on caring for older adults with multiple comorbidities. Almost 80% of people 65 and older report having a chronic illness, according to the Robert Wood Johnson Foundation.

Disease management programs don't come cheap, but thanks to industry collaboration, purchasers are increasingly learning how to assess the business case for these programs.

Evidence-based assessments of medical technologies can require specific criteria that meet government regulation as well as betters health outcomes.

For payers struggling with unmanageable cost increases in the business of delivering care, however, price cannot be overlooked. Insurers don't necessarily deny coverage of a treatment just because it's expensive, but they would be remiss if they didn't take cost into consideration, as well as safety and effectiveness.

As durable medical equipment (dme) becomes increasingly sophisticated, MCOs' challenges remain rooted in establishing medical necessity. To that end, most use strategies including prior authorization and coverage limits. Meanwhile, they must also satisfy changing state and national regulatory requirements.

IN THE WORLD OF professional sports, the competition isn't only on the gridiron, the court or the diamond. Just ask an MCO.

The economics and the politics behind the major healthcare problems affecting men, such as cardiovascular disease, cancer, obesity and depression, aren't receiving the attention they deserve. It has been the rule that women make health decisions for themselves and also for their male partners and their children. In contrast, most men have a more casual attitude toward their care: "if it ain't broke, don't fix it."

Grace seems an unlikely acronym for a study of acute coronary events, but given the findings of the Global Registry of Acute Coronary Events published in the Journal of the American Medical Association, the name may be apropos.

Worldwide, 388 million people will die from chronic diseases in the next 10 years. Chronic diseases account for about 75% of all healthcare costs. Clearly, disease management and prevention is sorely needed, but it's been a struggle to change the behaviors of large groups of people. A number of programs are finding success using non-traditional methods.

LOW-PREVALENCE rheumatoid arthritis (RA) has not gained attention equal to that of more common chronic diseases, but it has earned a spot on the list of complex diseases ripe for disease management.

LOW-PREVALENCE rheumatoid arthritis (RA) has not gained attention equal to that of more common chronic diseases, but it has earned a spot on the list of complex diseases ripe for disease management.

Disease management as we now define it may be on its last legs, though no one knows it yet. The Disease Management Purchasing Consortium has noticed that the savings in all but a few diseases doesn't offset the costs, and nowhere does it generate the level of return on investment (ROI) that some people think they are getting.

The centers for Medicare and Medicaid (CMS) says that 23% of Medicare beneficiaries have five or more chronic conditions but account for 68% of costs-not quite the 80/20 rule. And they tend to see many different doctors-about 14 a year with almost 40 office visits-and take as many as 10 medications at a time, according to Partnership for Solutions.

Last year acknowledged the 25th year since AIDS was first recognized, and to coincide with that anniversary, the U.S. Centers for Disease Control and Prevention (CDC) revised its recommendations for HIV testing for adults, adolescents and pregnant women in healthcare settings. The new guidelines remove the onus of determining who is at high risk for HIV infection and makes testing a routine part of medical care for all patients between ages 13 and 64 years.

Last year acknowledged the 25th year since AIDS was first recognized, and to coincide with that anniversary, the U.S. Centers for Disease Control and Prevention (CDC) revised its recommendations for HIV testing for adults, adolescents and pregnant women in healthcare settings. The new guidelines remove the onus of determining who is at high risk for HIV infection and makes testing a routine part of medical care for all patients between ages 13 and 64 years.