The Disease Management Care Blog looks at the question of hypertension, blood-pressure treatment, and the medical home model:
Long ago, the Disease Management Care Blog was a co-investigator in a multi-center high blood pressure (hypertension) research program. Everyone was treated with a precisely defined script and, compared to it’s regular patients, the blood pressure of all the DMCB’s research participants dropped. The DMCB concluded that that was thanks to two features of the research trial: 1) free drugs, and 2) a nurse devoted to making sure people took their free drugs.
That nurse helped convince the physician-DMCB that disease management could work.
“Could work,” with the emphasis on could, is also the context of this report by the expert health insurance actuaries over at Milliman, who examine the same potential of the patient centered medical home (PCMH) in the management of hypertension. In this handy and thoroughly researched review (63 references), authors Kathryn Fitch, Kosuke Iwasaki and Bruce Pyenson discuss how the PCMH could improve the treatment of hypertension thanks to its a) ongoing patient monitoring and treatment plans, b) use of telephonic and email outreach, c) concurrent co-morbidity management, d) efficient medication adjustments, e) liberal use of non-physicians for low-risk patients, f) increased patient-provider communication, g) coordination of specialist access and g) an ability to measure population-based outcomes.
All well and good, says the DMCB, but the reason why policymakers and other stakeholders may want to download the report is because it contains some key caveats…
Newsweek has released a new article looking at the coming Hepatitis C epidemic. Here is an excerpt:
Hepatitis C is a serious challenge for both doctors and public health officials, largely because of its long incubation period. An individual infected with hepatitis C can live the majority of their life not knowing they were infected. In fact, the new IOM report suggests this is usually the case: 75 percent of those with hepatitis C don’t even know they have it. And unlike other forms of the hepatitis virus, like A and B, there is no known vaccine. So the virus continues to be transmitted through exposure to infected blood, often injection drug use. Boomers may have also become infected by a blood transfusion or organ transplant before 1992, when officials began screening the blood supply for the disease.
Of those infected with the virus, about 60-70 percent will develop chronic liver disease. For about 40 percent, a months-long regimen of shots and pills will eradicate the virus. But many will continue to live with the disease as a chronic condition; 1 to 5 percent will die of the consequences of liver disease. Some expect to see these conditions become significantly more prevalent as Boomers’ cases move from virus to disease. One study, a Milliman Report published in May 2009, predicted that the number of patients with advanced liver disease will be four times greater than it is today by 2029. Cases of cirrhosis, scaring of the liver, will also quadruple.
Read the Milliman study here.
A new study looks at critical illness rates and provides further insight into the risks of smoking. As reported in National Underwriter:
A 25-year-old male non-smoker has a 24% chance of having a critical illness before reaching age 65 — and a 25-year-old male smoker has a 49% chance of incurring such an illness, according to the American Association for Critical Illness Insurance.
Analysts at Milliman Inc., Seattle, included those figures in a national critical illness risk assessment study prepared for the AALTCI, Westlake Village, Calif.
The Milliman analysts used a definition of critical illness that includes heart attacks, strokes, and life-threatening occurrences of cancer.
See the full NU article here and read other coverage here.
A Medicaid program in Massachusetts has spurred a 26% reduction in smoking rates, and has prevented various hospitalizations and care associated with asthma, heart attacks, and other conditions. See more here.
Smoking cessation programs are an example of a wellness benefit that demonstrably works.
A $.62 Federal tax on cigarettes is getting some ink this week, just as a House vote to give the FDA regulatory power over the tobacco industry attracted attention last week.
Some are framing these developments as part of the larger healthcare reform debate and even suggesting the tax could help reduce other healthcare costs. Do the cost claims hold up? Hard to say, though employer-sponsored smoking cessation programs pay for themselves, one of the few examples of wellness initiatives with a clear return on investment.
As we mentioned on Monday, the cost-savings potential of prevention and wellness is still uncertain. Milliman Principal Kate Fitch provides some perspective on this.
Wellness is often mentioned as a key component of healthcare reform yet the success of these programs is mixed.
We asked Kate Fitch for perspective based on lessons learned from the private sector.
Q: What wellness programs are most effective? Do some programs work better than others?
Kate Fitch: Program effectiveness goes beyond whether or not it “works.” Wellness programs should be evaluated in terms of both efficacy and value. Providing everyone with a personal trainer, personal nutritionist, and exercise equipment in the home might result in a few great outcomes. But if the cost becomes astronomical, or if the population affected by the program is insignificant, the value of the program comes into question.