HMOs need to share gains of DM programs. Physician are more likely to buy in if they see better outcomes--and financial rewards that go with them

Perhaps nowhere in medicine does the friction between physician and HMO translate into lost revenue more noticeably than in disease mnagement, where lack of doctor buy-in is a perennial complaint. The author, a former medical director knowledgeable about all aspects of DM, offers two methods by which health plans can overcome this obstacle.     

What are the best ways to get physicians the data they want and need?

Profiling is not a dirty word at Sentara Healthcare. From internal practice reports to hospital and HMO data, physicians increasingly are burdened by the information they have to provide to a variety of sources and the reports that come back to them afterwards. Adding physician profiling to that pile would be about as welcome as a mosquito bite. But at Sentara Healthcare in Norfolk, VA, physicians are uniformly happy about a new profiling effort.     

Mental health. 'People who really want to do this make a difference'

Birmingham's early intervention in psychosis service is the type the government would like to see across England, but roll-out can at best be described as patchy. Models of provision vary widely--from a standalone service to one fully integrated with other youth provision in the area. Research suggests early intervention could save as much as 53 percent on the cost of a conventional service.     

Practical and philosophical issues surrounding a national item bank: if we build it will they come?

Item response theory (IRT), item banking and computer adaptive testing (CAT) methods have the potential to provide novel platforms for the collection, analysis and dissemination of patient data on health status and well-being. There are considerable challenges associated with building and maintaining a national item bank and it is uncertain whether there is sufficient interest among key stakeholders for IRT-based and CAT measures. The most convincing activity is demonstrating that the approach is feasible, psychometrically sound and useful in different specific applications. Demonstrated success opens up the possibility of more widespread acceptability and application. As part of the development effort, there needs to be continued meetings and discussion with psychometricians, instrument developers, clinical researchers, the FDA, pharmaceutical industry researchers and a managed care organizations about the advantages and disadvantages of a national item bank.     

Rotavirus diarrhea disease burden in Peru: the need for a rotavirus vaccine and its potential cost savings.

OBJECTIVE: To assess the disease burden of rotavirus diarrhea in Peru as well the need for and the potential cost savings with a rotavirus vaccine in that country. METHODS: To assess the burden of rotavirus diarrhea in Peru, we reviewed published and unpublished reports where rotavirus was sought as the etiologic agent of diarrhea in children. Rotavirus detection rates obtained from these studies were combined with diarrhea incidence rates from a number of national surveys in order to estimate both the burden of rotavirus diarrhea in the country and its associated medical costs. RESULTS: Rotavirus is a significant cause of morbidity and mortality in Peruvian children. In their first 5 years of life, an estimated 1 in 1.6 children will experience an episode of rotavirus diarrhea, 1 in 9.4 will seek medical care, 1 in 19.7 will require hospitalization, and 1 in 375 will die of the disease. Per year, this represents approximately 384,000 cases, 64,000 clinic visits, 30,000 hospitalizations, and 1,600 deaths. The annual cost of medical care alone for these children is approximately US$ 2.6 million--and that does not take into account the indirect or societal costs of the illness and the deaths. CONCLUSIONS: Rotavirus immunization provides the prospect of decreasing the morbidity and mortality from diarrhea in Peru, but a vaccine regimen would have to be relatively inexpensive, a few dollars or less per child. Future cost-effectiveness analyses should explore the total costs (medical as well as indirect or societal) associated with rotavirus diarrhea. Newly licensed vaccines should be tested according to both their ability to avert deaths and their efficacy with fewer than three doses. All three of these factors could increase the cost savings associated with a rotavirus vaccine.     

Clinical microsystems, part 2. Learning from micro practices about providing patients the care they want and need

BACKGROUND: Usual medical care in the United States is frequently not a satisfying experience for either patients or primary care physicians. Whether primary care can be saved and its quality improved is a subject of national concern. An increasing number of physicians are using microsystem principles to radically redesign their practices. Small, independent practices-micro practices-are often able to incorporate into a few people the frontline attributes of successful microsystems such as clear leadership, patient focus, process improvement, performance patterns, and information technology. PATIENT FOCUS, PROCESS IMPROVEMENT, AND PERFORMANCE PATTERNS: An exemplary microsystem will (1) have as its primary purpose a focus on the patient-a commitment to meet all patient needs; (2) make fundamental to its work the study, measurement, and improvement ofcare-a commitment to process improvement; and (3) routinely measure its patterns of performance, "feed back" the data, and make changes based on the data. LESSONS FROM MICRO PRACTICES: The literature and experience with micro practices suggest that they (1) constitute an important group in which to demonstrate the value of microsystem thinking; (2) can become very effective clinical microsystems; (3) can reduce their overhead costs to half that of larger freestanding practices, enabling them to spend more time working with their patients; (4) can develop new tools and approaches without going through layers of clearance; and (5) need not reinvent the wheel. CONCLUSIONS: Patient-reported data demonstrate how micro practices are using patient focus, process improvement, performance patterns, and information technology to improve performance. Pati ents should be able to report that they receive "exactly the care they want and need exactly when and how they want and need it."     

High-risk proposition. With CMS' 'value-based purchasing' model, struggling hospitals are wondering if they can afford the IT needed to make it work

As the CMS pushes its "value-based purchasing" model, hospitals are left wondering if they'll get squeezed by a program that will require them to invest big bucks in technology. "People need to ... understand it is a way of transforming Medicare from a passive payer of claims to an active purchaser of higher-quality, more-efficient services," says the CMS' Thomas Valuck.     

Creating open access to exercise for low-income patients through a community collaboration for quality improvement: if you build it, they will come

Community health centers face the need for safe, accessible, and affordable exercise for low-income patients to implement self-management strategies. This study reports on one federally qualified health center's experience developing a partnership with a local YWCA to offer open access to patients for physical activity. Over a 24-month period, 1060 adult patients made at least 1 visit to the YWCA, logging a total of 14,276 visits. Among the exercisers, 112 had diabetes and made 3225 visits. Frequent users (> or =24 visits), had an HbAlc reduction of 1% (P = .02). Community health centers can collaborate with local exercise facilities to ensure that patients have opportunities to pursue healthier lifestyles.     

Medicaid managed care. From cost savings to accountability and quality improvement

Medicaid managed care is a work in progress. This article provides a brief historical overview of Medicaid managed care from the early 1980s to the late 1990s and offers insight into some of the major operational, fiscal, and political realities of implementing managed care in a Medicaid context. This article also attempts to show that a major advantage of managed care is having a more accountable health care system. Accountability can bring quality improvements to a system that often lacked the ability to measure performance and results under Medicaid fee-for-service. Subsequent articles in this journal demonstrate how states working together with managed care organizations and quality review organizations can better define, measure, and use quality information to improve their Medicaid managed care programs.