DorlandHealth

Richard Scott

More areas of the country are being served by fewer insurers this year, according to the American Medical Association.

The trend toward limited options for the average insurance purchaser in many areas has escalated to a state of quashed competition. In 24 of 43 states studied, at least 70 percent of the market was controlled by the two largest local insurers. The previous year saw 18 of 42 states with the same percentage of dual market presence.

AMA’s new study, “Competitions in Health Insurance: A Comprehensive Study of U.S. Markets,” looked at more than 300 metropolitan regions and found that nearly all—99 percent—are “highly concentrated,” resulting in a situation “where insurer consolidation may have harmful effects on patients, physicians, employers and the economy.” The study analyzed patient use of private insurers like health maintenance organizations (HMOs) and preferred provider organizations (PPOs).

Notes from the 10th Annual Population Health and Disease Management Colloquium

Richard Scott

This year, the leading population health and disease management conference continues its close relationship with two other top health care summits, operating in the same location as conference on retail clinics and another on the medical home model. The 10th annual Population Health and Disease Management Colloquium, sponsored by Philadelphia’s Jefferson Medical College, runs through Tuesday, March 2, and its shared quarters speak to growing trends in care delivery and adherence.

Taking place among the backdrop of the national debate on health care reform, the population health conference assessed the climate of many top reform points of address, such as chronic disease, preventive medicine, wellness, health promotion and comparative effectiveness research, among a panoply of other targeted areas. Monday’s morning sessions focused largely on that term close to case managers and related medical management professionals: care coordination.

Dr. Richard Wender, chair of Jefferson’s Department of Family Medicine, opened the sessions with a keynote address touching on the well-known burden of chronic disease in our country. “Our nation’s health is unconscionably poor,” he said.

Notes from the 10th Annual Population Health and Disease Management Colloquium

Richard Scott

Dr. Thomas Wilson, founder of the Population Health Impact Institute, also spoke during the morning session. His presentation focused on transitions of care and, like Dr. Wender’s exploration of the medical home model, Dr. Wilson explored the areas of health reform that, despite the proceedings on Capitol Hill, can be addressed without formal legislation.

He also addressed the need for transparency in wellness and population health programs, and the PHI Institute will host a free Webinar on March 11 at 1:00 p.m. to explore this issue. The Webinar, “The Value of Transparency for the Evaluation of Wellness and other Population Health Programs,” will be moderated by Ford’s corporate medical officer, Dr. Walter Talamonti.

Most of the initiatives being sculpted and the areas being addressed in Washington focus on the “demand” side of the health care equation. That is, they revolve around the patient, the patient’s needs, and the organizations and systems that a patient “uses.” Transitions of care, however, sit on the “supply” side of health care; they are part of—and can be addressed by—the various providers of care. Dr. Wilson, who refers to transitions as the “white space” that drifts unacknowledged by any health care provider, stresses the importance of accountability and attribution when it comes to transitions—of both people and information.

Unnecessary hospital readmissions are not just a substantial cost burden, but they can carry with them markers of inadequate quality and represent a rupture of care at some point along the patient’s intake-stay-discharge experience.

Reducing avoidable readmissions has become a viable object of study itself, evidenced by the pioneering work of projects like Eric Coleman’s Care Transitions Program at the University of Colorado and Mary Naylor’s Center for Transitions and Health at the University of Pennsylvania. The innovators of both programs, along with another two dozen related experts, brought their ideas together at the behest of the Health Research & Educational Trust, which published in January a compendium of their analyses in an instructional guide called Health Care Leaders Action Guide to Reduce Avoidable Readmissions.

The action guide collects the working—and effective—aspects of the various models, measures them out, and boils them down to create a “starting point” from which not only hospital leaders but health care practitioners in many roles can establish and implement practical changes within their own organizations and practices.

A study published in Cancer in January reveals that doctors routinely wait too long to discuss end-of-life concerns with terminally ill patients, which can lead to underinformed choices. The study questioned doctors about their communication practices with cancer patients who have four to six months to live. Forty-six percent said they would talk about do-not-resuscitate status at that time, along with 26 percent who would talk about hospice and 21 percent about preferred site of death. The delay in communication can delay patient empowerment and limit choice. The National Comprehensive Cancer Network advises that these talks take place when a patient has less than a year to live.