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The Caregiver Act and AARP’s CARE Act Aim to Reduce Readmissions

Hospitals nationwide have gone to great lengths in an effort to reduce readmissions and improve patient quality. However, despite these concerted efforts, hospitals continue to incur fines from Medicare for excessive rates of patient readmissions, which are projected to total more than $428 million. Even worse, readmissions cost patients a collective $17 billion.

Eric Heil, RightCare

Eric Heil, RightCare

However, these numbers and rates are starting to drop thanks to new tools and programs, such as the Delivery System Reform Incentive Payment (DSRIP) Program. We’re also seeing new legislation being introduced in several states aimed at reducing readmissions by ensuring hospitals and their patients communicate better after they are discharged.

The Caregiver Act and AARP’s model state bill, called the Caregiver Advise, Record, Enable (CARE) Act, are examples of legislation currently being discussed in several states. Together, they have the potential to prevent hundreds of thousands of unnecessary hospital readmissions. Oklahoma was the first in the nation to pass legislation back in November 2014 and New Jersey followed suit later the same month.

The new laws would require hospitals to work directly with a patient’s caregiver (usually a family member) to ensure that necessary preparations are in place for the patient to successfully recover at home after being discharged. This process includes providing discharged patients and their caregivers with a clear path to follow for addressing medication, nutrition and living needs in-home.

To achieve this level of customized, high quality care, technology is essential to streamline the care coordination process and support the unique needs of patients. RightCare, a growing medical technology company, has an end-to-end software solution designed to assess patient risk and needs at the time of admission, ensure the most appropriate post-acute care plan is offered, and seamlessly transition patient information to post-acute care providers. RightCare’s software is based on 10 years of academic and clinical research and has helped hospitals nationwide optimize workflow, reduce length of stay times, reduce readmissions and ensure hospitals meet Medicare-mandated standards for preventable readmissions.

We’ve seen time and time again how effective post-care planning with providers, community organizations and technology can significantly decrease readmissions, so it’s encouraging to see these efforts are now supporting caregivers.

Readers: Are you a family caregiver? What are some of the challenges you face, and what tools are you using to help? Let us know in the comments.

Lowering Hospital Readmissions through Remote Monitoring of Post-Acute Patients: The University of Virginia Health System – Broad Axe Care Coordination Model

One of the less known policies of the Affordable Care Act, the Hospitals Readmission Reduction Program, requires that hospitals with higher than national average readmission rates for certain medical conditions and surgical procedures be penalized.  For many hospitals, the readmission penalties result in millions of dollars in profit lost.

David Sheon

David Sheon

A recent Wall Street Journal article shines a light on remote patient monitoring and post-acute care coordination, a service that is experiencing rapid growth and focusing on readmission rate reduction.  The service not only helps more people recover successfully from hospital stays, but it also keeps costs down for payers and helps hospitals avoid the risk of growing penalties.

According to an October 2014 article from Kaiser Health News, “Medicare is fining a record number of hospitals – 2,610 – for having too many patients return within a month for additional treatments, federal records released {recently} show. Even though the nation’s readmission rate is dropping, Medicare’s average fines will be higher, with 39 hospitals receiving the largest penalty allowed.”

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Leading manufacturers of remote-monitoring equipment include Medtronic Inc., Philips NV and St. Jude Medical Inc., according to the Wall Street Journal article. Sales are expected to total about $32 billion this year, with a compound annual growth rate of 9.2% between 2014 and 2019.

In addition to addressing readmissions, effective remote monitoring represents an outstanding care redesign technique that can be implemented as part of a CMS bundled payment initiative, or as part of the quality program of an accountable care organization or clinically integrated network. The benefits accrue well beyond avoiding the penalties.

“The remote monitoring technology and implementation drives revenue issues beyond the CMS readmission penalties,” said John Kirsner, Partner, Jones Day, an expert on the implications of the ACA on hospitals. “In addition to the penalty avoidance component, this technology can assist in creating shared savings that result in additional topline revenue enhancement.”

Some remote monitoring programs are further along than those mentioned in the Wall Street Journal article. For instance, over a year and half ago, Broad Axe Care Coordination and University of Virginia Health System (UVA) partnered to design and execute a comprehensive platform combining services and technology to reduce readmissions for key conditions where Medicare was imposing penalties, including heart attack, heart failure, pneumonia and COPD.  Because of the success of the program and Medicare’s expansion of the penalty conditions, Broad Axe expanded its service at UVA to remotely monitor patients who had total joint replacements as well. The result for UVA has been a dramatic decrease in joint readmission rates, and a ready for prime time remote monitoring/care coordination program that can be put into place at hospitals across the country.

The system, called C3 at UVA, is a remote care management platform that combines telehealth services from experienced clinicians with robust analytics and an IT platform integrated with the health system’s EMR to provide UVA with a fully-outsourced care coordination solution.

BACC_Image for blog_SM (1)“Broad Axe offered us something unique: a care coordination center that combines outstanding technology with dedicated clinicians — RNs, LPNs, and CNAs — to deliver ongoing care transition and care coordination services,” said Amy L. Tucker, MD, Associate Professor of Cardiovascular Medicine, University of Virginia Health System.  “We’ve seen a great impact on the readmission rate.”

UVA and Broad Axe work together to look closely at those patients who are readmitted to see if the program can be further optimized.

For example, C3 can track not only readmission but when patients have follow-up visits.  The system also can help to ascertain whether patients are following their medication instructions. This provides important feedback to see what areas of opportunity are most important for the health system to target to improve patient care.

Broad Axe executives are pleased with readmission rate performance between 25 and 45 percent below historical benchmarks, depending on the condition and payer population, and the associated penalty savings for the hospital.

“Historically, the adoption of remote monitoring technology has been stymied by the lack of financial incentives to use the technology,” said Scott Edelstein, also a Partner at Jones Day, specializing in regulated medical technologies. “Recent CMS initiatives such as the Hospital Readmissions Reduction Program and new reimbursement codes for remote chronic care management are fueling a renewed interest in this technology. This should create significant opportunities to increase access to, and quality of, care while lowering costs.”

Do you work in a hospital consider remote monitoring? What are your concerns? Or are you a recent patient who has participated in remote monitoring? www.RealWorldHealthCare.org welcomes your feedback.

Categories: Cost-Savings, General

The Hospital Fast Food Debate: How a Simple, Low-cost Idea can Improve What People in Hospitals Eat

Back in April 2012, nearly two dozen hospitals that host fast food restaurant chains received a letter from an advocacy group asking them to evict their fast food tenants and to “stop fostering a food environment that promotes harm, not health.” But as it turns out, many of these outlets offer options that are nutritious in addition to unhealthy options, and the same can be said about many hospital-owned cafeterias.  In fact, a review by the Physicians Committee for Responsible Medicine (PCRM) found that some hospitals with fast food vendors also had their own cafeterias with equally unhealthy options.

David Sheon

David Sheon

Meanwhile, some fast food companies, such as McDonalds, have worked hard to improve nutritious options. Others, such as Burger King, should be acknowledged for adding veggie burgers.

Perhaps the debate over having these chains located in hospitals is misplaced. Perhaps the more important factor in helping customers make healthy decisions is labeling nutritious food in an easy to understand manner.

Hospitals appear to be able to convince cafeteria customers to buy healthier food by adjusting item displays to have traffic light-style green, yellow and red labels based on their level of nutrition.

According to a recent report by HealthDay News:

“Our current results show that the significant changes in the purchase patterns … did not fade away as cafeteria patrons became used to them,” study lead author Dr. Anne Thorndike, of the division of general medicine at Massachusetts General Hospital in Boston, said in a hospital news release. “This is good evidence that these changes in healthy choices persist over time.”

As part of the study, labels — green, yellow or red — appeared on all foods in the main hospital cafeteria. Fruits, vegetables and lean sources of protein got green labels, while red ones appeared on junk food.

The cafeteria also underwent a redesign to display healthier food products in locations — such as at eye level — that were more likely to draw the attention of customers.

The study showed that the changes appeared to produce more purchases of healthy items and fewer of unhealthy items — especially beverages. Green-labeled items sold at a 12 percent higher rate compared to before the program, and sales of red-labeled items dropped by 20 percent during the two-year study. Sales of the unhealthiest beverages fell by 39 percent.

“These findings are the most important of our research thus far because they show a food-labeling and product-placement intervention can promote healthy choices that persist over the long term, with no evidence of ‘label fatigue,'” said Thorndike, an assistant professor of medicine at Harvard Medical School.

Perhaps we should worry less about whether food vendors in hospitals are fast food chains, and more about labelling nutritious choices and positioning them to encourage healthy eating. What do you think? Would clear labelling of healthy choices affect the way you eat at hospitals? Would this translate outside of the hospital setting?

Categories: General

Give Patients the Gift of Hope and Health by Supporting HealthWell for #GivingTuesday

We are proud to announce that the HealthWell Foundation – an independent 501(c)(3) charity that provides financial assistance to insured patients living with chronic and life-altering illnesses – is joining the #GivingTuesday campaign, which launches today. 100 percent of your donation to HealthWell goes directly to grants and services that will benefit patients in need across the country. This week we are sharing some powerful real-world examples of how your gift to HealthWell will help transform lives.

Lynn Harcharik

Lynn, who received financial assistance from HealthWell for cancer treatments.

As one of our country’s most trusted independent charities, we believe that no patient, including those living with cancer, should go without health care because they can’t afford it. By donating to HealthWell for #GivingTuesday, you’ll join us in making that commitment a reality that will change lives for the better, one patient at a time – just like Lynn.

It was ovarian cancer spreading to the colon. My husband called many places, no cancer society would help! One society asked what type of cancer it was, and replied: there are no funds for ovarian cancer – we cannot help. Another organization had already used their funds. It was very discouraging, but my oncologist’s secretary told us about the HealthWell Foundation. After calling and talking to your group, the answer was YES, you would help. (Thanks!) In October of 2008, reversal surgery was done with the ileostomy. And yes, the cancer came back, or maybe was not completely gone from before, but-more chemo! Thank you for being there in my time of need. My prayers are with your group and your work. Thanks!

– Lynn (Streator, IL)

We want to make a difference for even more patients like Lynn so they can access critical medical treatments and get better. But that can only happen with your support.

That’s why, for this year’s #GivingTuesday, we’re urging Real World Health Care (RWHC) Blog readers to donate to the HealthWell Foundation’s Emergency Cancer Relief Fund (ECRF). Your generous holiday gift will help ensure that patients living with cancer are not forced to choose between paying the rent or buying food and affording life-saving care.

So what, specifically, will your tax-deductible #GivingTuesday donation do? Giving to ECRF will bring us closer to meeting our $100,000 goal by the end of the year so the fund can open in January. We are almost halfway there with more than $46,000 raised so far. Every dollar counts, and with just a little more help, we will hit our goal so that more cancer patients can start 2014 off right.

To help more families and patients afford the urgent medical treatments they desperately need, we need you to support #GivingTuesday starting today. Please contribute as generously as you possibly can.

Thank you for giving the gift of health this holiday season.

Categories: Cost-Savings

Groundbreaking Report Spotlights Benefits of Going Green for Hospitals

The Healthier Hospitals Initiative (HHI), a program that encourages hospitals to go healthier for patients by going greener, is marking its one-year anniversary by releasing the first-ever report (2012 Milestone Report) that quantifies the success of sustainability initiatives among hospitals in the U.S. and Canada.

HHI is made up of 13 sponsoring health systems and three nonprofit organizations including Health Care Without Harm, The Center for Health Design and Practice Greenhealth. As we reported in June, many hospitals are exploring ways to lower costs through environmentally friendly options and sustainable energy strategies.

Paul DeMiglio

Paul DeMiglio

“The HHI Milestone report shows that hospitals are increasingly embedding sustainability into their core operating system,” said Gary Cohen, President of Health Care Without Harm and Founder of HHI.  “HHI also offers hospitals a powerful way to meet the Triple Aim of improving the patient experience, addressing population health and lower their costs.”

The report demonstrates how the green efforts of 370 hospitals are translating to substantial cost-savings and a reduction in waste. In addition to recycling more than 50 million pounds of materials and saving approximately $32 million from single-use medical device reprocessing, the report also found that participating hospitals are:

  • Preventing 61 million pounds of waste from going to landfills (among 44 member hospitals).
  • Creating more healthful meals for their patients by limiting overall meat intake, decreasing the amount of meat served by 10 percent from 2010-12.
  • Increasing the overall amount of money spent on healthful beverages from 10 percent to 62 percent.
  • One hospital reported purchasing more environmentally friendly cleaning supplies, spending on average more than 37.75 percent of their cleaning supply budgets on green cleaning products.

“At Practice Greenhealth, our strength comes from the collective expertise and knowledge that members bring to the table about what works to make our health care more sustainable,” said Laura Wenger, RN, Executive Director of Practice Greenhealth. “HHI’s 2012 Milestone Report is proof that hospitals of all sizes benefit from this wisdom.”

The Commonwealth Fund 2012 report found that if health care organizations, such as hospitals, adopted sustainable practices, industry savings could add up to an estimated $5.4 billion in 5 years and more than $15 billion over 10 years.  The study also concludes that health systems that embrace green initiatives are examples for the health care system as a whole to follow.

“As part of a preventive approach to controlling chronic disease, increasing numbers of hospitals have committed to minimizing adverse environmental impact of their operations on patients, staff, and the community, serving as role models for the health sector and society at large,” the study authors noted.

Are health systems in your community embracing green initiatives? What do you see as the major barriers to more hospitals going green and what incentives could be created to overcome these challenges?

Categories: Cost-Savings

(Medical) Home is Where the Care and Cost-Savings Are

The word “home” has many connotations: the building in which you live, the place you come from, and even the end point of a game. Now, there is a new type of home: The Patient-Centered Medical Home (PCMH).

Linda Barlow

Linda Barlow

PCMH is a model of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible and focused on quality and safety. It has become a widely accepted – and cost-effective – model for how primary care should be organized and delivered, encouraging providers to give patients the right care in the right place, at the right time and in the manner that best suits their needs.

“The magnitude of savings depends on a range of factors, including program design, enrollment, payer, target population, and implementation phase,” explains Michelle Shaljian, MPA, Chief Strategy Officer of the Patient-Centered Primary Care Collaborative (PCPCC). “Most often, the medical home’s effect on lowering costs is attributed to reducing expensive, unnecessary hospital and emergency department utilization.”

When the Affordable Care Act (ACA) was signed into law in 2010, medical homes got a boost because of numerous provisions that increased primary care payments, expanded insurance coverage and invested in medical home pilots, among other programs.

The model has been adopted by more than 90 health plans, dozens of employers, 43 state Medicaid programs, numerous federal agencies, hundreds of safety net clinics and thousands of small and large clinical practices nationwide since then. Among the results:

  • In Michigan, Blue Cross Blue Shield – the nation’s largest PCMH designation program — saved an estimated $155 million in preventative claim costs over the first three years of implementation.
  • CareFirst Blue Cross Blue Shield in Maryland reported nearly $40 million savings in 2011 and a 4.2 percent average reduction in expected patient’s overall health care costs among 60 percent of practices participating for six or more months.
  • In New York, the Priority Community Healthcare Center Medicaid Program in Chemung County saved about $150,000 or 11 percent in the first nine months of implementation, reduced hospital spending by 27 percent and reduced ER spending by 35 percent.
  • In Pennsylvania, Pinnacle Health achieved a zero percent hospital readmission rate for PCMH patients versus a 10-20 percent readmission rate for non-PCMH patients.

The PCPCC is the leading national coalition dedicated to advancing PCMH. According to PCPCC, the medical home is an approach to the delivery of primary care that is:

  • Patient-centered: A partnership among practitioners, patients and their families ensures that decisions respect patients’ wants, needs and preference, and that patients have the education and support they need to make decisions and participate in their own care.
  • Comprehensive: A team of care providers is accountable for a patient’s physical and mental health needs, including prevention and wellness, acute care, and chronic care.
  • Coordinated: Care is organized across all elements of the broader health care system, including specialty care, hospitals, home health care, community services and supports.
  • Accessible: Patients access services with shorter wait times, “after hours” care, 24/7 electronic or telephone access, and strong communication through health IT innovations.
  • Committed to quality and safety: Clinicians and staff enhance quality improvement through the use of health IT and other tools to ensure that patients and families make informed decisions about their health.

According to Melinda Abrams, Vice President of Patient-Centered Primary Care Program at the Commonwealth Fund, to have the greatest impact, a medical home must be located at the center of a “medical neighborhood” inhabited by hospitals, specialty physicians, physical therapists, social workers, long-term care facilities, mental health professionals and other service providers. She notes that it is the role of the primary care provider to coordinate care and make sure that patients don’t slip through the cracks, or receive tests or procedures they’ve already had – a particular concern for patients who see multiple doctors.

The National Committee for Quality Assurance (NCQA) – a non-profit, independent group dedicated to improving health care quality – accredits and certifies a wide range of health care organizations and is the leading national group that recognizes PCMH with the most widely adopted model. Currently, there are almost 5,000 NCQA Recognized PCMHs across the country.

Other organizations with PCMH recognition programs include Accreditation Association for Ambulatory Health Care, Inc. (AAAHC), the Joint Commission, and URACVideos from the American Association of Family Physicians (AAFP) feature family physicians who discuss practice redesign aimed at lowering costs, maximizing staff expertise and improving patient care.

“Practices seeking to initiate a patient-centered medical home will find that an assessment process is very helpful to understand where they are,” said Shaljian. “Some practices have electronic health records, a very strong history of team-based care, and strong connections with specialists, hospitals, and other stakeholders in the community, while others do not. Some are deeply affected by an internal culture of quality improvement, which makes a huge difference in how successful some medical homes are.”

Want to learn more about PCMH? Visit the U.S. Department of Health & Human Services’ Agency for Healthcare Research and Quality content-rich Resource Center.

How can health care continue to move the nation to PCMH? And how can the model tackle its number-one challenge: the current fee-for-service payment system?

Personal Connections with Pharmacists Drive Medication Adherence Outcomes

With nearly half of all patients in the US not taking their medications as prescribed, medication non-adherence remains a dangerous and expensive problem that costs the health care system $329 billion annually (Express Scripts Drug Trend Report), meaning more hospitalizations and visits to the emergency room (ER).

Paul DeMiglio

Paul DeMiglio

So what’s the good news? Effective, comprehensive solutions are emerging to reverse this trend by involving the pharmacist to improve medication adherence rates through a personal connection with patients.

Recent stories underscore how pharmacists are uniquely positioned to engage patients in conversations that help them understand why treatments are prescribed and why meds should be taken as directed.

A report released on June 25 by the National Community Pharmacists Association (NCPA), for example, illustrates how interpersonal relationships between pharmacists and patients boost adherence. Authors of the report found that a patient’s sense of connectedness with one’s pharmacist or pharmacy staff was the survey’s “single strongest individual predictor of medication adherence.”

“Pharmacists can help patients and caregivers overcome barriers to effectively and consistently follow medication regimens,” NCPA CEO B. Douglas Hoey, RPh, MBA, said in a statement. “Indeed, independent community pharmacists in particular may be well-suited to boost patient adherence given their close connection with patients and their caregivers.”

According to the American Pharmacists Association (APhA), one effective method pharmacists can use to improve adherence is medication therapy management (MTM) services for patients taking more than one drug for multiple chronic medical conditions. In addition to therapy reviews, pharmacotherapy consults, anticoagulation management, immunizations, health and wellness programs and other clinical services, MTM involves the following elements:

  • Comprehensive medication review, including a personal medication report that lists all the medications the patient is taking.
  • Medication action plan.
  • Education and counseling or other resources to enhance understanding about using the medication and to improve adherence.
  • Coordination of care, including documenting MTM services, providing the documentation to other providers, and referring patients to other providers as needed.

Pharmacists can also leverage a variety of practical tips to help patients improve adherence that include:

  • Discussing the appropriateness of each medication and its impact on their multiple medical conditions.
  • Evaluating the effectiveness and safety of each medication.
  • Assessing whether some medications may be unnecessary and should be discontinued.
  • Discussing the need to change medications or doses if problems arise.

The implications of improved adherence will help lower the cost of treating chronic conditions, decrease hospitalizations, reduce ER visits and by extension lower the risk of treatment failures, serious adverse reactions and deaths too.

“Studies have repeatedly recorded the cost-saving effect of MTM,” said Kevin Schweers, Senior Vice President, Public Affairs, NCPA. “One Minnesota study found a 12:1 return-on-investment for MTM.  In North Carolina, Kerr Drug reports that MTM programs for seniors produced a 13:1 return. Improved adherence would likely help reduce hospitalizations as well. So many prescription drugs are intended to treat chronic conditions, such as heart disease, that can result in hospitalization. In addition, hospital re-admissions can result from the failure to stick to a prescribed medication regimen.”

Joel Zive, adjunct clinical faculty, University of Florida College of Pharmacy, underscored the need for patients to cultivate relationships with their pharmacists.

“While MTM services are quite important in helping adherence, getting to know your pharmacist’s name is helpful in establishing a relationship with your pharmacist,” he said. “Pharmacists are trained to pick up clinical clues from patients.  This is why if you are having unusual reactions medications, speaking to your pharmacist is an option.”

Although MTM services are an effective way to increase adherence, greater participation among patients and pharmacists is needed according to the APhA and the National Council on Patient Information and Education (NCPIE).

In addition to leveraging tips and strategies to boost adherence, pharmacists can also draw on a number of resources for patients, referring them to the NCPIE wallet card and to a brochure made available by NCPIE and the Agency for Healthcare Research and Quality (AHRQ), “Your Medicine: Be Smart. Be Safe.”

What else can pharmacists do to engage patients? How can stakeholders in health care, government, academia and the private sector collaborate to improve dialogue among pharmacists and patients around strategies that increase adherence?

Hospitals See Early Signs of Cost-Savings through Energy Efficiency Project

Hospitals are notorious for being energy hogs. With 24/7 operation, lots of energy-consuming equipment, and strict codes for lighting, air circulation and heating/cooling, there should be little wonder why. In fact, it’s estimated that the operation and construction of hospitals uses five percent of all the energy consumed in the U.S. (ENERGY STAR).

Linda Barlow

Linda Barlow

Targeting 100! is making inroads to reverse this trend. The research project is a roadmap for hospital design, construction and operation, seeking to develop more energy-efficient hospitals at little additional first capital cost investment from the owner. It provides climate-specific guidance for hospitals to achieve the goals of the 2030 Challenge for 2010-15, with a 60 percent energy reduction from the current U.S. average energy performance while complying with U.S. energy and health-related codes and improving the quality of healing and work environments.

“At a time when health care reimbursements are decreasing for many health care organizations, spending on energy is one area that can become less costly with greater efficiency,” said Heather Burpee, Research Assistant Professor, Health Design & Energy Efficiency, University of Washington. “Reducing energy use also has a direct impact on carbon emissions, thus having a positive impact on environmental health.”

Though energy represents a small portion of a hospital’s overall operating costs, reducing utility expenditures can create a low-risk, high-yield and stable investment:

  • $1 of net savings translates into $50 of gross revenue.
  • For a typical Targeting 100! hospital that saves 60 percent on energy and 35 percent on annual utility costs, the average annual savings of $575,000 equates to $28.5 million in gross revenue that would have otherwise been generated through providing patient services.

“In this way, the operations of the hospital are less expensive and the extra ‘revenue’ can be used to service additional care, acquire new equipment or go back into additional energy efficiency upgrades,” Burpee said.

According to Targeting 100!, one of the biggest uses of energy within a hospital is re-heating centrally cooled air. For example, at Vancouver, Washington’s Legacy Salmon Creek Medical Center (LSCMC), a 220-bed, state-of-the-art facility – which acted as a benchmark for the program – re-heat consumed 40 percent of the hospital’s energy.

The Targeting 100! program saves re-heat energy expenditures by reducing loads on the building envelope through solar control, turning down air changes in unoccupied areas, and other mechanical ventilation strategies.

Burpee highlighted several recent Targeting 100! projects that are starting to demonstrate positive results:

The Swedish Issaquah Hospital in Issaquah, Washington is exceeding its energy goal of 125 kBtu/SF (amount of heat required to change the temperature of one pound of water by one degree fahrenheit at sea level) per year by a significant margin after just nine months.

Seattle Children’s Bellevue Clinic at the University of Washington Medical Center is on track to see an annual energy cost benefit of approximately $1.32 million – a return on investment of more than 50 percent that will pay back the provider’s investment in less than two years. According to the project’s engineer, the total investment needed to implement the energy-reduction strategies amounted to less than one year of typical operating costs.

“Developing a healthier and more sustainable hospital environment requires an exceptionally high level of owner support to achieve carefully gauged high performance goals,” Burpee said. “A project team structure and culture that enables cooperative decision-making with key stakeholders is essential for creating a truly high-performance hospital: one that has a low-energy footprint and embodies qualities that foster health, productivity, and well-being.”

Targeting 100! notes that implementing energy-efficiency options incurs a three percent incremental cost premium, with the inclusion of a utility incentive, and that cost savings in some categories can offset incremental cost increases for energy improvements in other areas. These energy options would pay back, on average, in less than 11 years, a nine percent return on investment.

Should a three percent increase in capital cost be considered “cost-neutral?” Are relatively modest increases in initial costs for strategies that yield projected long-term energy savings a good investment?

Categories: Cost-Savings

Targeted Therapies Open Door to Improved Outcomes and Lower Costs to Treat HCV

As we were reminded on World Hepatitis Day, early detection is critical to turning the tide of this “silent epidemic” that impacts millions. However, strategies to end the deadly effects of viral hepatitis don’t stop there. Personalized treatment is another essential tool that fuels better outcomes for patients with hepatitis C (HCV) while saving money in the long term for the health care system too. 

Paul DeMiglio

Paul DeMiglio

The importance of finding effective therapies for HCV is underscored by the reality that the disease often goes undetected, with an estimated 80 percent of Americans with HCV unaware of their status. Many HCV-positive people show mild to no symptoms, making it more likely for the illness to progress and become more expensive to treat as a result. 

Although safe and effective vaccines are available for hepatitis A and B, none exist for HCV. To help answer this need, Abbott created the fully automated RealTime HCV Genotype II Test – the first FDA-approved genotyping test in the United States for HCV patients – to facilitate targeted diagnosis and treatment that boosts desired outcomes.

This treatment-defining genotyping test empowers physicians to better pinpoint specific strains of HCV, determine which treatment option is best for the patient, and make more informed recommendations about when it should be administered. Available to individuals with chronic HCV, the test is not meant to act as a means to screen the blood prior to diagnosis.

So how does finding the right HCV treatment save money?

Targeted therapies like these are important for diseases like HCV because they reduce the “trial and error” of having to use additional treatments when the initial ones don’t work, saving money and time for patients and providers. Early detection, combined with follow-up care, can prevent patients from developing later stages of hepatitis that can mean more serious long-term conditions that are harder and more expensive to treat.

Treating HCV patients with end-stage liver disease, for example, is 2.5 times higher than treating those with early stage liver disease. Advanced HCV can also escalate to chronic hepatitis infection, a side effect of this being cirrhosis (scarring of the liver and poor liver function) and liver cancer. Treatment for these two conditions (which can include a liver transplant) can cost more than $30,000. Liver cancer treatment can be more than $62,000 for the first year, while the first-year cost of a liver transplant can be more than $267,000.

As more and more patients find themselves unable to afford treatments, HCV is becoming an increasingly larger financial burden on the health care system.

The annual costs of treating HCV in the United States could be up to $9 billion, and over the course of a lifetime the collective cost associated with treatments for chronic HCV is estimated to total $360 billion.

“As we see patients with more advanced liver disease, we see significantly more costs to the system,” says Dr. Stuart Gordon, author of the Henry Ford Study. “The key, therefore, is to treat and cure the infection early to prevent the consequences of more advanced disease and the associated economic burden.”  

Targeted therapies show great promise to improve outcomes while saving time and money by linking patients to the specific treatments they need at earlier points of diagnosis. But what can health systems do to make innovations like the HCV Genotype II Test accessible to more patients and increase the cost-savings benefit on a larger scale?

Real-Time Health Alerts Join Twitter to Expand Access to Public Health Information

Is Twitter now monitoring your allergies or sleeping patterns?

Linda Barlow

Linda Barlow

In today’s era of real-time information, Twitter has emerged as a leading go-to source for the latest in news, entertainment and more. Now, Twitter is joining Everyday Health, Inc. to create HealthBeat, the first global real-time health alert and news offering. The partnership seeks to provide relevant health information and breaking news to the Twitter community in real time, offering promoted Tweets linking to Everyday Health’s news, expert advice, videos and tools that users can put into action.

HealthBeat will scour the 2 million daily health-related tweets in the U.S. to identify impending outbreaks and other health crises.

“We’ll be looking at the key health terms flaring up every day, and when something is indexing in an abnormal way, we’ll let Twitter know and we’ll supply content about what to do,” said Everyday Health President Michael Keriakos, in an interview published in Ad Age.

For example, Keriakos noted that HealthBeat could have been used to provide vaccination information to residents affected by a whooping cough outbreak in South Central Los Angeles two years ago.

Not only will the partnership provide important information relating to public health, it will also serve as a targeting mechanism for advertisers who are being sought by HealthBeat to promote content around broad health topics like allergies, flu season and insomnia.

While HealthBeat touts itself as the “first global real-time health alert” service, there are other online services – like Google’s flu tracker — that provide similar information on a regional or national level:

  • Launched in 2010, Health & Safety Watch is a Canadian-based web portal and iPhone app that lets users customize the type of alerts they want to see. It also indicates when an advisory or warning is over, for example, when a local water quality issue has been resolved.
  • In the U.S., the Centers for Disease Control and Prevention (CDC) provides alerts about health issues travelers may face when going abroad as well as alerts about disease outbreaks at home.
  • Also in the U.S., a service called HealthMap, developed out of Boston Children’s Hospital, offers an online portal called The Disease Daily, and a mobile app called Outbreaks Near Me.

“The sooner we get a signal of an infectious disease outbreak, the sooner we can devise an appropriate response, and hopefully, the negative impacts can be mitigated,” explained Anna Tomasulo, MA, MPH, HealthMap Program Coordinator, Boston Children’s Hospital.

According to Tomasulo, HealthMap has other tools that help prevent health problems.

“Our Vaccine Finder takes a person’s zip code and provides information on where they can access vaccines nearby,” she says, noting that the project started with flu vaccines but has since been expanded to other vaccines including human papillomavirus (HPV), measles, mumps and rubella (MMR), Varicella and more. “A questionnaire helps users determine what vaccine is most appropriate and provides a list of participating pharmacies within a given radius that provides the vaccine the user needs. Such vaccines help prevent costs associated with illness and potential hospital stays.”

So are HealthBeat, HealthMap and other real-time alert programs providing an important public health service? Are these alerts helpful or will they cause undue concern?

Categories: Access to Care