Managed Care - November 2008 - (Page 35)

Plans Slow to Cover At-Home BP Monitoring Because readings in the clinic are unreliable and are a questionable guide to diagnosing and treating high blood pressure, self-monitoring deserves a look By Lola Butcher Contributing Editor magine a world in which the most frequent reason for physician office visits went away — and you are imagining the future. Three medical associations recently issued new guidelines for home blood-pressure monitoring to become a primary way in which hypertensive patients manage their disease. Home monitoring, done properly, is now believed to provide a more accurate assessment of a patient’s blood pressure levels than physician-office monitoring. Home monitoring alone does not necessarily lead to better control, but, according to the new guidelines, it could do so if the more accurate readings are used to improve treatment decisions. What is known: Better control of blood pressure leads to fewer strokes and heart attacks. “We know from our own studies and others that when patients are capable of using home blood pressure monitors and they do it effectively, physicians can do everything by telephone,” says Nancy Houston Miller, RN, former president of the Preventive Cardiovascular Nurses Association. “They can diagnose a patient, they can treat, they can titrate medicines, and they can determine adherence.” Miller, associate director of the cardiac rehabilitation program at Stanford University Medical Center, is a co-author of the new joint scientific statement from the American Heart Association, the American Society of Hypertension, and the nurses association They hope their call for home blood pressure monitoring is the first step in a transformation of how hypertension is treated. “To move away from blood-pressure monitoring as the single most common reason for an office visit is going to be a huge system shift, in terms of not only how we do things but payment as well.” Most health plans do not yet support home monitoring by reimbursing patients for the equipment or paying physicians for their services associated with home monitoring. But many are looking for ways to improve blood pressure control — and with good reason. “There’s lots of devastating illnesses out there but cardiovascular disease is still the No. 1 killer, and hypertension is a part of that,” says Ken Patric, MD, vice president and chief medical officer at Blue Cross Blue Shield of Tennessee. “Hypertension is also probably the single greatest cause of congestive heart failure.” I Scope of the problem Uncontrolled hypertension is considered the most preventable — and possibly the most expensive — health problem in the world. By 2025, according to a recent Journal of the American Medical Association article, more than 1.5 billion people worldwide will have hypertension, which will account for 50 percent of heart disease risk and 75 percent of stroke risk. More than 70 million Americans have hypertension, and only 37 percent of those successfully control their blood pressure, Miller says, although medications and knowledge about lifestyle influences have been available for decades. The payoff for controlling blood pressure seems clear: For each 10-mm Hg decrease in systolic blood pressure, the average risk of dying from heart disease falls by 30 percent — and the risk of dying from cerebrovascular disease decreases by 40 percent. The use of home blood pressure monitors, readily available at retail outlets at relatively low cost, has been increasing steadily in recent years. Indeed, 64 percent of hypertensive patients owned a monitor in 2005, according to a Gallup poll, and 55 percent said that they monitor their blood pressure at home. NOVEMBER 2008 / MANAGED CARE 35

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

Managed Care - November 2008 Editor’s Memo Contents News and Commentary Legislation & Regulation Letters Medication Management Compensation Monitor Do It Yourself for Less Biomarkers Promise, but Do They Deliver? Oncologists Complain About Drug Payment Consider Blood Pressure Self-Monitoring Q&A: Keep Industry in the Game Formulary Files Plan Watch Tomorrow’s Medicine Outlook Respiratory Syncytial Virus Managed Care Considerations Contents Continuing Education Objectives RSV Disease in the Pediatric Population In the Trenches RSV Infection in the Adult Population Health Plan Medical Director Health Plan Pharmacy Director RSV Issues and Solutions Assessment/Evaluation/Certificate Request Post-Test

Managed Care - November 2008

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