EVIDENCE-BASED MEDICINE IS PIVOTAL IN ADVANCING CARE MANAGEMENT
Evidence-based Medicine and Managed Care: Applications, Challenges,
Results of a
National Program to Assess Emerging Applications of Evidence-based
Medicine to Medical Management Strategies in Managed Care
Center for Evidence-based Medicine, December 2003
Health plans touch
all facets of healthcare and therefore have a unique opportunity to
stimulate adherence to evidence-based practices....The purpose of
this program was to explore how managed care is applying principles
and concepts of evidence-based medicine to its delicate balancing of
cost and quality management.
Some of the key
1) The role, scope
and functions of medical management in managed care organizations
are expanding dramatically. There are five key impact areas: a)
Disease and case management, b) provider profiling & reports cards,
c) pay for performance, d) consumer-directed care, and e) coverage &
resources/budgets for medical management programs do not correlate
with enrollments or other measures of plan size.
health costs is a primary consideration in most medical management
directors in managed care believe the application of evidence-based
medicine is central to enhancements in each of the key impact areas.
PEW INTERNET PROJECT UPDATES WEB
America's Online Pursuits: The Changing Picture Of Who's Online And
What They Do
& American Life Project; December 22, 2003
A broad analysis of
over three years’ worth of Pew Internet Project data illustrates
shifting trends in Internet use by Americans:
has consistently grown
growth in activity, the growth of the online population itself has
use the Internet in different ways.
the quality of online connections matter.
experience with the commercial side of the Internet has expanded
dramatically in spite of the economic slump.
to be the “killer app” of the Internet.
Big news stories
drive lasting changes in the news -seeking audience online.
There has been a
surge in use of the Internet for health or medical information.
of Internet users have said “yes” when we asked the simple
question: Do you ever use the Internet to get health or medical
information? However, when we asked about 16 specific kinds of
health searches (seeking diet and fitness information, material
about health insurance, mental health information, etc.), the
percentage of Internet users who had done health searches came to
number of those who have done health searches online grew at least
59%, from a figure of 46 million in March 2000 to 73 million in
Online women are much more likely than online men to have done
health searches using the Internet.
The Internet has
increasingly become an important source of health-care and medical
information for the majority of online American adults. Those health
seekers who turn to the Internet as a reference for health
information grew substantially from 54% in March 2000, to 66% of the
online population in December 2002.
RETURN ON INVESTMENT FOR DM? -- THE
The Cost Savings of Disease Management Programs: Report on a Study
of Health Plans
Association of Health Plans, November 2003
with the single-plan studies reported in the peer-reviewed
literature, the eight evaluations that AAHP/HIAA surveyed found that
enrollees in DM programs had fewer hospital admissions and fewer
emergency room (ER) visits, and lower overall costs. Thus, these
evaluations are supportive of the hypothesis that DM programs
contribute to reductions in health care costs....The eight
evaluations presented here break new ground in overcoming the
limitations of previous research on disease management. Unlike some
earlier studies, these evaluations are valid because they address
important methodological issues, such as the statistical phenomenon
known as regression to the mean. And these evaluations are
generalizable because they cover multiple health plans, different
areas of the country, and a diverse range of people of various ages
from different socioeconomic backgrounds.
Disease Management: A Leap of Faith to Lower-Cost, Higher-Quality
Studying Health System Change, October 2003
expectations, evidence of both disease management and case
management programs' success in controlling costs and improving
quality remains limited.
Evaluating ROI in State Disease Management Programs
Health Issue Brief, November 2003
Be careful out there!
the financial return associated with DM is difficult because changes
in health care costs over time cannot be assumed to be solely due to
the DM intervention in the population that received DM services....
Given the uncertainty associated with DM analyses, it is probably
not possible to “prove” that DM positively affects ROI by the legal
standard of “beyond a reasonable doubt.” A more reasonable goal is
to aim for a “preponderance of evidence.” That means that ROI
assessments should not be based on a single study. Rather, evidence
should be refreshed constantly with new data. This will assure those
who pay the health care bills that the investments they made months
or years earlier were intelligent ones.
Why We Can't Wait to Implement Disease Management
Health; October 15, 2003
Just do it anyway.
don't yet know if the promise of cost reduction will materialize
fully, but the target is enormous and the early indications are
encouraging. We can hold back until every single skeptic is
satisfied, or we can get to work on the roots of health expenditure
with a potent new tactic.
PREDICTIONS FOR HEALTHCARE IN 2004
Healthcare’s Top Business Issues and Responses for 2004
Ernst & Young;
December 16, 2003
The Top 10 Issues:
1) A new level of
business rigor in technology investments.
2) Transformation of clinical care through technology.
3) Detailed redesign of core business processes.
4) Outsourcing of non-core functions.
5) Protracted efforts to comply with HIPAA requirements.
6) Collaboration between payers and providers at an operational
7) Proliferation of “new” benefits models.
8) Redirection of medical management efforts.
With efforts to reduce administrative costs largely exhausted
and medical costs continuing to rise, healthcare organizations are
taking a new view of medical management. They are looking at
advanced care management, or population health management
approaches. This involves the use of predictive modeling techniques
to identify “at risk” patients who are about to incur large claims.
Technology enables prioritized outreach to these people to prevent
complications. Employers (typically) offer support programs to
modify patients’ behavior and thus avoid costly hospitalizations or
procedures down the road....
on organizational ethics and institutional governance.
10) Community approaches to new biological threats
Six Prescriptions To Ease Rationing In U.S. Health Care
KaiserNetwork.org; December 22, 2003
Wall Street Journal article (paid subscription required)
Wiring the health system
2) Evidence-based medicine
3) Fixing reimbursement
4) Disease management
Many experts agree the best opportunity to
improve care and stave off costly complications is disease
management -- the strategy of monitoring people with chronic
conditions such as diabetes, congestive heart failure and coronary
artery disease. Those diseases are expected to cost $510 billion
this year and soar to $1.07 trillion by the 2020. But many of those
costs are related to preventable hospitalizations and emergency-room
Redesigning the intensive care unit
6) Getting patients involved
Forrester's Top 10 Healthcare Predictions For 2004
Research, December 15, 2003
Predicts 2004: Healthcare
challenges and increasing volatility have resulted in a floundering
and troubled U.S. healthcare industry. However, there are glimmers
of hope for 2004.
Research; December 16, 2003
DIABETES INFO ON THE INTERNET --
Design and Testing of a Tool for Evaluating the Quality of Diabetes
Consumer-Information Web Sites
Medical Internet Research, Oct-Dec 2003
There is wide
variation in the accuracy and comprehensiveness of online diabetes
information and no existing mechanism for consumers to get detailed,
objective information about true Web site quality. Furthermore, this
research also demonstrates the limited utility of using proxies such
as sponsorship characteristics to help guide consumers in searching
for health Internet information.
This research also
highlights the alarming amount of inaccurate and incomplete Internet
information on diabetes. Given the increase in consumer use of the
Web to make health care decisions, the potential threats to patient
care are substantial. If diabetes information is incomplete, a
consumer may not be aware of all the various complications of
diabetes and thus not know to get tested for certain conditions. If
a consumer finds inaccurate information on the Web, he or she may
not be aware, for example, of the symptoms that indicate the onset
of an acute diabetic event.
Home Health Care Technology Report -- A New Publication!
Nancy A. Brown, Associate Editor: Robert Roberts
best new technology, applications, and practices for delivering
quality health care in the home....and the legal, regulatory and
reimbursement fundamentals you need to understand to succeed.
Home Healthcare: Wired and Ready for Telehealth -- Just
Published, the New and Revised Nurses and Nursing Students Edition
hard copy and electronic formats. Call Audrey Kinsella at (301)
581-0090 or email
A primer and
practical planning guide.
Future Care 2004 Healthcare Web Summit
Presentations by 30 faculty on key trends shaping the business of
“Disease Management: State-of-the-Industry 2004 and Beyond”
Kuraitis, Principal, Better Health Technologies
teleconference on Tuesday, January 20, 2004 at 12:00 PM Eastern Time
Managed Care Online (MCOL)
Emerging Technologies in Disease Management: Improving Quality,
Martin, Chairman and CEO, I-trax
Kuraitis, Principal, Better Health Technologies
teleconference on January 28, 2004 at 1:30 PM Eastern Time
Healthcare Intelligence Network,
RECENT RESEARCH ON PATIENTS WITH
Multiple Chronic Conditions: A Challenge to the 21st Century
Center on an Aging Society, Georgetown University, November 2003
multiple conditions, however, are substantially more likely than
adults with one chronic condition to report accomplishing less,
spending more time in bed sick, missing work, not working, living
with less income, and having poor mental health.
Trends in Chronic Condition Comorbidities in a Group Health Plan
for Solutions, October 2003
This analysis looks
at some basic trends among the privately insured who have chronic
conditions by analyzing claims data from 1999 through 2001.... among
enrollees with a chronic condition, the proportion with multiple
chronic conditions increased slightly and there was a commensurate
decrease in the proportion of enrollees with no chronic conditions.
Managing Multiple Conditions: A Challenge For Medicare
project in North Carolina has cut costs and improved care for
patients with chronic diseases. Can Medicare do the same?
Medical News; December 1, 2003
TELEMONITORING FOR HEART FAILURE
A Systematic Review of Telemonitoring for the Management of Heart
Journal of Heart Failure, October 2003
observational studies and six randomised controlled trials involving
telemonitoring and heart failure were identified.
Telemonitoring might have an important role as part of a strategy
for the delivery of effective health care for patients with heart
failure. Adequately powered multicentre, randomised controlled
trials are required to further evaluate the potential benefits and
cost-effectiveness of this intervention.
DM AND TELEHEALTH TECHNOLOGY UPDATES
• Smart Bandages • Contamination Information • RFID • Intelligent
Agents • 3-D Computer Imaging • Artificial Intelligence • Personal
Monitoring Networks • Email Protocol • Radiosurgery • Smart Cards •
Informatics, January 2004
Gadgets help baby boomers navigate old age
November 17, 2003
E-Mail A Day May Keep Doctor Away
patients go online to renew prescriptions, or describe symptoms
News; January 4, 2004
Assessing Technology Needs for the Elderly: Finding the Perfect
Match for Home
Telehealth Opportunities for Home Care Patients
The Cardiac Connection Program: Home Care That Doesn't Miss a Beat
Home Care Technology and Telehealth-The Future Is HERE!
Healthcare Nurse, October 2003
Computer-Based Technology And Caregiving For Older Adults Conference
Priorities for Retirement Years (SPRY) Foundation; October 9, 2003
Big Sites Enter Into Diabetes Monitoring Market
offer millions of patients the means to manage chronic conditions
over the Internet.
Medical News; September 22/29, 2003
Home-based Health Services: Telefónica’s Pilot
Dave’s Report on the Broadband Home; September 23, 2003
Heart Patients May Benefit From Sensors In Clothes
October 8, 2003
Technology That Makes You Healthy
October 16, 2003
Telemonitors Can Provide 'Virtual Assisted Living'
Star Tribune; December 1, 2003
DMAA Applauds Medicare Prescription Drug And Modernization Act Of
Management Association of
The Hidden Epidemic: Finding a Cure for Unfilled Prescriptions and
Consulting Group; December 15, 2003
How Broadening DM's Focus Helped Shrink One Plan's Cost
Care, November 2003
Promoting Prevention Through Information Technology
of Health Center Affiliated Health Plans, October 2003
Reducing The Growth Of Medicare Spending: Geographic Versus
Affairs; December 10, 2003
Predictive Models Make Smart Purchasers
Health; January 10, 2004
Obesity Is on the Rise and Costing Employers Billions
Perrin Point of View, 2003
Diabetes cases could double in developing countries in next 30 years
Organization; November 14, 2003
Disease Management -- Attracting and Retaining Participants: A
A Report on the Evaluation of Criteria Sets for Assessing Health Web
WebWatch; September 30, 2003
Chronic Conditions and Disabilities: Trends and Issues for Private
Fund, October 2003
Examining Chronic Care in California’s Safety Net
Healthcare Foundation, October 2003
How Different Is California? A Comparison Of U.S. Physician
groups and IPAs provide better chronic illness care and report being
no worse off financially.
Affairs; October 15, 2003
Payers See Savings in Eliminating Risk Clauses in Disease Management
Week; November 3, 2003
The Decade Preceding Medicare Coverage
Center on an
Aging Society, Georgetown University, October 2003
Disease Management for Chronic Obstructive Pulmonary Disease
Pharmaceutical Council, September 2003
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diseases, Better Health Technologies is an eHealth and disease
management consulting company that can assist you with
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