Tag Archives: Helen Blumen

Healthcare and MPL costs related to preventable adverse drug events

Harmful medication errors, or preventable adverse drug events (ADEs), are prominent quality and cost issues in healthcare. Injectable medications are important therapeutic agents, but they are associated with a greater potential for serious harm than oral medications. The economic burden of preventable ADEs associated with inpatient injectable medications and the associated medical professional liability (MPL) costs had not been previously described in the literature.

This study finds that the healthcare and MPL costs associated with preventable ADEs are substantial. The authors estimate that inpatient preventable ADEs associated with injectable medications increase annual U.S. payor costs by $2.7 billion up to $5.1 billion, while MPL costs associated with injectable medications total $300 million to $610 million annually.

The study was published in the December 2012 issue of American Health & Drug Benefits.

CO-OPs and community health centers: Kindred spirits

Consumer operated and oriented plans (CO-OPs) share many similar values with the community health centers (CHCs) that are supported by the Health Resources and Services Administration (HRSA). Both are nonprofit with consumer-majority governing boards, and the population that currently obtains care through CHCs will likely account for many of the members that CO-OPs enroll. This edition of Milliman’s CO-OP Point of View newsletter discusses how CO-OPs and CHCs are currently in alignment and may be poised for mutual success. Click here to view the newsletter.

Double the ACOs

Yesterday, Health & Human Services announced 89 new accountable care organizations (ACOs), doubling the number of Medicare ACOs.

With this in mind we’ve pulled together all of our ACO research into a single location. Here you go:

Also, this video offers a nice overview of the ACO concept.

Full steam ahead for Medicare/Medicaid EHR incentives

As reported in Modern Healthcare, the Centers for Medicare and Medicaid Services (CMS) has provided nearly $4.5 billion in electronic health records (EHR) incentive payments. About $2.4 billion of that is under Medicare, which started EHR incentives in May 2011. The rest is under Medicaid, which began EHR incentives in January 2011. Hospitals have received the bulk of the total in both programs, about $3.1 billion. The program has more than 225,000 active accounts. The EHR incentive program is part of the American Recovery and Reinvestment Act of 2009, which authorized $19 billion for the EHR incentive program.

For a couple of Milliman perspectives on the EHR program, check out this paper on state healthcare data exchanges which points out how:

Community-based data pooling initiatives in Minnesota, Massachusetts, Oregon, Washington, and Wisconsin (commonly known as Chartered Value Exchanges or CVEs) have already shown that, at least using administrative data, it is possible to bring stakeholders to the table, get appropriate infrastructure in place, and begin using community health data to improve quality and transparency. These organizations may serve as models or building blocks for more meaningful use of EHR data nationally.

It’s also worth taking a look at this 2009 research report, “The Convergence of Quality and Efficiency and the Role of Information Technology in Healthcare Reform,” which discusses how EHR can move beyond administrative efficiency to become a decision support tool for physicians.

You can download the latest EHR program data from CMS here.

Checking in on ACOs

With accountable care organizations (ACOs) soon to serve more than a million Medicare patients, it is clear that this model of care delivery is receiving an unprecedented test of its viability, and, if it works as intended, may reshape how healthcare is paid for on a larger scale. Cigna alone plans to have more than a million people enrolled in ACOs by 2014, and says it believes that ACOs are going to be important regardless of the Supreme Court’s ruling on the Patient Protection and Affordable Care Act (PPACA).

With so much focus on the topic, it’s worth taking a look back at some of the research and analysis on ACOs published by Milliman on the topic over the past couple of years.

First, for a good summary of ACOs—what they are and how they work—start with this overview video featuring a number of Milliman experts.

For many observers, the key question about ACOs is whether they represent a financially viable model compared to fee-for-service. Effective financial management will be key to success. Milliman has produced a number of relevant papers:

With all the attention on Medicare ACOs, it’s easy to forget that they exist in the private market, as well. For more on such entities, look at “ACOs Beyond Medicare,” which describes the potential advantages for providers who partner with a private insurer rather than with CMS. A 2011 Managed Healthcare Executive roundtable featuring Milliman consultant Rob Parke also discussed ACOs in the private market.

A number of other papers have also been published discussing various aspects of ACOs such as:


ACOs and evidence-based guidelines

Accountable care organizations (ACOs) are an operational and reimbursement healthcare model that is intended to help achieve the dual goals of managing healthcare costs while improving quality of care. Evidence-based guidelines for care management hold great potential for helping ACOs meet these goals in several ways, such as by promoting best practices, by assisting with payment allocation among providers of care, and by facilitating communications among providers and between providers and patients. This paper presents clinical referral guidelines as an example of how evidence-based guidelines can affect and enhance the accountable care concept.