Category Archives: Prevention

An actuarial analysis of lung cancer screening

Bruce Pyenson presented his study on lung cancer screening at Health Affair’s “Value in Cancer Care” briefing on April 12 in Washington DC. Watch his presentation at – scroll down to “The Case For Lung Cancer Screening of High-Risk Patients & Improving Payment And Delivery Of Cancer Care.”

Also, here is the study’s abstract:
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Moving towards prevention?

Edward JhuJason NowakowskiAccording to a recent article in the Washington Post, early data shows recent upticks in utilization of some preventive services by Medicare patients, presumably triggered by provisions in the healthcare reform law encouraging use of preventive care. Medicare enrollees can now obtain wellness checkups and screening tests for cancer and other serious conditions at no cost, for example.

Interestingly, the article notes that so far only the more general procedures, wellness exams, have seen significant bumps in utilization. At this early stage, it appears that utilization of more invasive screening procedures such as mammograms or colonoscopies is relatively flat even with the removal of cost sharing under health reform.

This could well speak to the heart of the preventive challenge itself, and certainly raises many questions: Will we ultimately see utilization remain stubbornly close to current benchmarks for some procedures? If removing copays is not sufficient, what kinds of incentives are necessary to get people to use the clinically-recommended levels of services? Where does education fit into the larger goal of persuading people to use them? If the right kind of utilization is incented, what will be the long-term cost implications?

Moving forward, it will be more important than ever for providers and carriers to attempt to answer these questions. Our recent report, “Benchmarking Preventive Care Utilization,” points out that there are “numerous problems that actuaries and other analysts may expect to encounter as they attempt to set baselines and benchmarks for preventive services”—not the least of them is agreeing on and communicating a definition of “preventive services” in the first place. Other issues are related to claim coding complexities, billing, medical innovations, considerations for “at-risk” patients, and finding ways to distinguish screening and diagnostic procedures.

The Washington Post article is only an early indicator, and it introduces more questions than answers. The march toward increased use of preventive care will be one of the more interesting aspects of reform to monitor as the American healthcare system goes through this period of evolution.

Benchmarking preventive care utilization

Under the provisions of the Patient Protection and Affordable Care Act (PPACA), all health plans (other than those that choose to remain grandfathered) will be required to provide preventive services without copays, coinsurance, or other cost sharing. Although there is no way to tell exactly how the PPACA requirements will affect preventive care trends, it is safe to say that use of preventive services overall is likely to increase. This paper discusses existing preventive care utilization rates and compares them to a calculation of the recommended utilization rates.

Healthcare hot spots: The costliest city blocks in Camden, N.J.

Sometimes the idea that keeping people healthy reduces costs can break down, but sometimes it actually works. A new article by Atul Gawande (subscription required) looks at one such instance. Here is an excerpt from the article, in which a young doctor named Jeffrey Brenner, in Camden, N.J., applies some of the statistical techniques he used as a volunteer police reform commissioner to identifying healthcare “hot spots” in his hometown:

[Brenner] made block-by-block maps of the city, color-coded by the hospital costs of its residents, and looked for the hot spots. The two most expensive city blocks were in north Camden, one that had a large nursing home called Abigail House and one that had a low-income housing tower called Northgate II. He found that between January of 2002 and June of 2008 some nine hundred people in the two buildings accounted for more than four thousand hospital visits and about two hundred million dollars in health-care bills. One patient had three hundred and twenty-four admissions in five years. The most expensive patient cost insurers $3.5 million.

We’ve blogged before about geographic cost disparity in healthcare, though never at so granular a level. Given the hope attached to reducing admissions and readmissions as a way of controlling healthcare costs, it seems reasonable that a formula that identified “super utilizers” as they are called and focused on improving their care (and minimizing unnecessary utilization) would help to reduce costs.

Mobilizing around diabetes?

We have talked before about diabetes. Today, the Task Force for the National Conference on Diabetes issued a diabetes-related call to action:

The Call to Action seeks to address diabetes prevention, diagnosis, treatment and management, as well as to identify the practices and resources required to meet the needs of people with, and at risk for, diabetes,” said Steve Edelman, M.D., a practicing endocrinologist and Founder and Director of Taking Control of Your Diabetes, one of the members of the Task Force.

Diabetes currently affects nearly 24 million people in the U.S.(1) and is expected to reach 32 million by 2031.(2) (p.2,l.81-2) Modeling by Milliman, an actuarial firm, indicates that diabetes-related costs could increase from 10 percent of U.S. health expenditures in 2011 ($340 billion) to 15 percent by 2031 ($1.6 trillion).(2) (p.2,l.90-2)

Read more here.

Actuarial study anticipates, supports recent findings on lung cancer screening

Some of you may remember this interview from last May, which explained the results of a 2009 study for the Lung Cancer Alliance that used actuarial methods to clarify the opportunity posed by lung cancer screening.

The case for increased lung cancer screening gained more momentum last week when the Los Angeles Times reported on the results of an analysis by the National Cancer Institute. Here is an excerpt from the Times article:

Advanced CT imaging can reduce deaths from lung cancer by 20% among heavy smokers by detecting tumors at an earlier stage when they are more treatable, according to results released Thursday from the first study to compare the value of CT scans and regular chest X-rays for lung cancer screening.

The long-awaited results of the trial involving more than 53,000 former and current heavy smokers were so conclusive that the study was terminated ahead of schedule last week and letters were sent to all the participants advising them of the results.

The findings are considered a major step forward in fighting the most deadly form of cancer — which is expected to kill an estimated 157,000 Americans this year — because chest X-rays have never been proven to be an effective tool for identifying tumors. CT scans are more powerful and provide a much clearer picture of the lungs.