Managed Care - June 2008 - (Page 16)

NEWS AND COMMENTARY 400 percent. MRI and CT rates also rose more than 50 percent. “Health care costs are increasing by double digits and imaging is one of the major drivers of this,” says Mitchell. The other driver is physician self-referral, according to the study. In contrast, relative changes in the use of advanced imaging performed at hospitals were small. Mitchell points to the average physician net income, which declined by 7 percent from 1995 to 2003 after adjusting for inflation. “The cutback in payment of the Medicare fee schedule for surgical procedures and the volatile stock market during this time period” are factors for the increase in imaging scans says Mitchell. costs increased by double digits at 10.6 percent. This is a trend we expect to continue for several years, as fewer high-volume drug patents expire.” Medical costs are determined by the number, type, and cost of health care services that are utilized and the amounts that the employee’s health plan pays medical providers for these services. 5 Big Plans Promise PHR Portability Insurance industry executives from Anthem, UnitedHealth, Health Net, Kaiser Permanente and Aetna, along with California insurance commissioner Steve Poizner, have joined to ensure that patients can transfer their personal health records (PHRs) between insurance companies. A PHR is a tool used to manage an individual’s medical information. Nearly all insurers offer PHRs, but few patients are using them at present. Using a PHR ensures that a member’s entire medical history is available, to use as the member sees fit, regardless of insurer at any given time. Operating like a calendar of medical events, PHRs can contain information about doctor or hospital visits, prescription information, or test results. PHRs can also include information that the member wishes to enter such as information about childhood vaccines, living wills or organ donation wishes, and next of kin contact information. “The expanded use of personal health records will improve patient care and potentially reduce medical costs,” says Poizner. Because much of the PHR is filled in automatically by the member’s insurer, the PHR is likely to be up to date and accurate. Medical Costs Rise For Family of Four Your typical American family of four is going to have $15,609 in medical expenses this year. That’s an increase of more than $1,100 from last year. That number is reported in the fourth annual Milliman Medical Index (MMI), which tracks the average yearly health care costs when the family of four is covered by an employer-sponsored preferred provider organization (PPO). The new study determined that the average annual cost for a family of four increased by 7.6 percent from 2007 to 2008. This was lower than the 8.4 percent average annual rate of increase for the period 2003–2007. The report emphasizes, however, that the burden of overall expense is steadily shifting to employees. “The MMI examines the key drivers and the components of actual medical spending, including physician charges, prescription drugs, and hospital charges,” says Gary Brace, a principal and study coauthor. “Over the past year . . . prescription drug Headlines On Deadline . . . CMS proposed new protections for Medicare beneficiaries in Medi- care Advantage and prescription drug plans by providing more regulation on door-to-door marketing and coldcalling, as well as new proposed requirements pertaining to broker/ agent commissions. The proposal goes beyond what the health care insurance industry recently endorsed as necessary regulatory changes to the program for development. “This is an important step to ensure beneficiaries can rely on information being provided to make Medicare coverage decisions that are right for them,” says Karen Ignagni, president and CEO of America’s Health Insurance Plans (AHIP). AHIP is reviewing the new regulations and is developing detailed comments. . . . The age of a business may affect a manager’s decision to offer health benefits, according to a new report from the Henry J. Kaiser Family Foundation. The report suggests that for smaller and mid-sized establishments, the likelihood of offering coverage is positively associated with the age of the business. Insurers may want to give special focus to the issues faced by small businesses just starting up or in the early years of operation. Special subsidies or products for these businesses may be needed to encourage these businesses to purchase, and their workers to enroll in, health plans. The analysis is based on data from the insurance component of the Medical Expenditure Panel Survey. . . . A recent study published in the British Medical Journal suggests that blood glucose selfmonitoring is not cost-effective. In a randomized, controlled trial, 184 people with newly diagnosed type 2 diabetes were placed in either a self-monitoring group or in a control group that did no self-monitoring. Researchers found no significant difference in HbA1c, body mass index, or use of oral hypoglycemic drugs. However, patients in the self-monitoring group had higher on depression in the study’s well-being questionnaire. — Tony Berberabe 16 MANAGED CARE / JUNE 2008

Table of Contents Feed for the Digital Edition of Managed Care - June 2008

Managed Care - June 2008 Editor’s Memo Contents Viewpoint Letters News and Commentary Legislation & Regulation Medication Management Compensation Monitor Plans Chart Course in Rough Waters A Conversation With Barbara Starfield, MD Smoke Signals from Payers Slow Going for Clinical Decision Support Back Pain and Physical Therapy Formulary Files PlanWatch Outlook

Managed Care - June 2008

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