Managed Care - November 2008 - (Page RSV15)

180,000 hospital admissions each year at a cost exceeding $1 billion. RSV also is recognized as an important cause of viral pneumonia in adults. Preventive measures, such as hand washing, are paramount, especially in hospitals and nursing homes where many immunocompromised patients reside. When RSV is circulating, it is advisable to minimize contact between high-risk patients and children. agents causing acute respiratory infection in a San Francisco University Medical Center Clinic during the influenza season. Clin Infect Dis. 2005;41:822–828. Ramadan HH, Farr RW, Wetmore SJ. Adenovirus and respiratory syncytial virus in chronic sinusitis using polymerase chain reaction. Laryngoscope. 1997;107:923–925. Thompson WW, Shay DK, Weintraub E, et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003; 289:179–186. Disclosure: Julio A. Ramirez, MD, FACP, has received grant and research support from Pfizer, Cubist Pharmaceuticals, Merck & Co., and Wyeth Pharmaceuticals. He is on the speaker’s bureau for Pfizer, Cubist Pharmaceuticals, Merck & Co., Ortho-McNeil, and Schering-Plough. He reports no real or apparent conflicts of interest with respect to proprietary products mentioned in this article. References Falsey AR, Hennessey PA, Formica MA, et al. Respiratory syncytial virus infection in elderly and high-risk adults. N Engl J Med. 2005;352:1749–1759. Louie JK, Hacker JK, Gonzales R, et al. Characterization of viral Health Plan Medical Director: Considerations for Prevention and Management of RSV Disease ALBERT TZEEL, MD, MHSA Market Medical Officer, Great Lakes Region Humana Wisconsin, Waukesha, Wis. Health plans play an important role in the managetechnology investment in Humana’s history. CareHub is ment of respiratory syncytial virus (RSV) disease. Joseph a collaborative guidance model that engages both plan Juran, the great pioneer in quality control who passed members and their health care providers by leveraging away last March, always talked about the cost of poor technology to share information among members, physiquality in manufacturing, and said that the cost cians, and Humana’s internal nurses, who work of prevention is less than the cost of inspection with our disease management vendors to imand less than the cost of internal and external prove medical outcomes. CareHub identifies failure. Certainly the cost of preventing a disease pediatric members by mining claims received. is going to be less than the cost of the disease itIt does not identify adult members, because self. Humana’s intent is to make sure that all our there currently is no indication for the use of members who are candidates for RSV immunoRSV immunoprophylaxis in adults. prophylaxis do, in fact, receive it. The heart of CareHub is an evidence-based At Humana, RSV management is guided by rules engine. This tool applies accepted clinical the three I’s: Integration of data, Identification guidelines to an algorithm that helps us idenALBERT TZEEL, of individuals who should receive immunoprotify specific candidates for clinical engagement. MD, MHSA phylaxis, and Interaction with both plan memBy mining members’ clinical profiles and anabers and physicians. Successful outreach begins with lyzing their individual data, we can identify and evalucandidate identification. To that end, we continuously ate potential candidates for appropriate interventions mine our patient/physician database, which contains and then route those candidates to those interventions. about 4 terabytes of data (by comparison, the Library of CareHub also enables us to conduct personalized interCongress’s data warehouse contains about 20 terabytes). active communication campaigns via multiple channels. These data are fed into CareHub, the largest information Creating a clinical profile Humana is a 47-year-old publicly traded health and supplemental benefits company serving 11.5 million members in about 20 key markets nationwide. The clinical profile generated with CareHub provides a unique view of every plan member. The profile incorporates data from medical claims (diagnoses, using ICD- SUPPLEMENT / RSV 15

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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