The Health Shopper

The Associated Press and Washington Times have reported that U.S. Census Bureau since 1995 has overestimated the number of uninsured in America. The cause: a computer error. Revised estimates released by the bureau on Friday report that 44.8 million residents, or about 15.3% of the population, lacked health insurance in 2005. The previous estimate was 46.6 million residents, or about 15.9% of the population. Rep. Carolyn Maloney (D-N.Y.) said, "While it is certainly good news that fewer Americans are uninsured than previously reported, this raises major questions," adding, "For an agency that specializes in statistics, 1.8 million is not a minor error …"

Giving health consumers online access to their claim and health histories is one more step in consumer empowerment. Blue Cross patients across the nation are now getting a tool to help them manage their healthcare online.

A new program called '360 Health' is being launched across the nation. Anthem Blue Cross and Blue Shield in Maine, Blue Cross of California, Anthem Blue Cross and Blue Shield in Connecticut, Blue Cross and Blue Shield of Georgia, and Anthem Blue Cross and Blue Shield in New Hampshire have all adopted the new health program that leverages technology to enable consumers to better manage their healthcare.

360 Health integrates health management programs and tools into a centralized, consumer-friendly online resource that assists members in navigating the health care system, using their health benefits and providing information to access comprehensive and appropriate care. A key future component of 360 Health is MyHealth Record, an online personal health record owned and managed by members. MyHealth Record is automatically populated by member-provided information plus claims data received by WellPoint, Anthem's parent company. Claims can be accessed from any computer with an Internet connection, allowing members to track and share their health histories.

No big surprise here. A new study reveals that patients are 58 percent more likely to switch to a more cost-effective prescription drug or a lower-cost pharmacy channel when they can comparison shop for drugs. The analysis, conducted by Medco Health Solutions, Inc., found that patients are willing to price shop on prescription drugs when presented with clear information on their clinical alternatives, channel options and overall savings – critical member- engagement insights to successfully manage health care costs.

When prices are transparent – like they are at Vimo for medical procedures and health insurance – consumers are ready and willing to make decisions that will save them money. Medco's study of more than 55,000 users of medco.com, showed that nearly 14 percent of members had their prescriptions changed to a lower-cost alternative after using Medco's "Savings Advisor tool" — a 58 percent increase in conversion compared to the rigorously defined control group that did not access the online shopping tool. Results unearthed a critical finding: half of the total conversions initiated by members and approved by their physicians were from brand-name drugs to generic drugs. And about 25 percent switched from buying drugs from a pharmacy to a less-expensive mail-order channel.

Hospitals in the Midwest are setting new national standards for clinical outcomes, patient safety, financial performance, efficiency, and growth in patient volume.

This is according to the Solucient list of 100 top hospitals released this month. The 2006 winners from the 14th edition of the study were announced in the March 12 issue of Modern Healthcare.

More than half of the winning hospitals in the 2006 study are from the Midwest, and 30 of the 100 Top Hospitals facilities are in two states — Michigan and Ohio. When researchers evaluated hospital performance on a state-by-state basis, nine out of 12 Midwest states placed in the top two quintiles (a "quintile" is a fancy word for a fifth). The Midwest was also the top region in hospital performance in the 2004 edition of the 100 Top Hospitals national study.

At the other end of the spectrum, nearly two-thirds of states in the South (10 out of 17) ranked in the lowest two quintiles.

Six states were ranked in the top quintile in both 2004 and 2006 (Kentucky, North Dakota, Ohio, South Dakota, Washington state, and Wisconsin), while seven states remained mired in the bottom quintile in both studies (Alaska, Hawaii, Nevada, New Jersey, New York, South Carolina, and Wyoming). Furthermore, three of the most populous states — California, New York, and Texas — placed in the two lowest quintiles in both studies.

Other findings from the study demonstrate that quality really is a life-and-death issue:

– If all hospitals performed like the benchmark hospitals, more than 100,000 additional patients could survive each year, and an additional 114,000 could avoid complications.
— With 25 percent higher admissions per bed, benchmark hospitals treated more patients than non-winning hospitals and also treated patients who were sicker and required more complex treatment.

The better hospitals also paid their staffs more. Salaries and benefits were $3,200 more a year per full-time staff member at benchmark hospitals.

Abuse of emergency rooms is a huge reason that healthcare costs are spiraling out of control. While emergency rooms are equipped with expensive equipment and specialists prepared to deal with life-threatening traumas, many people head to them with simple illnesses – often expecting their insurance to pick up the tab. Ultimately, it makes healthcare more expensive and helps contribute to higher insurance premiums.

What effect does the adoption of high-deductible health plans (HDHPs) have on this problem? A new study by the Department of Ambulatory Care and Prevention (of Harvard Medical School and Harvard Pilgrim Health Care), published in the March 14 Journal of the American Medical Association, found that there was a reduction in emergency room use by HDHP holders for less severe conditions like colds, nausea, and headaches. The authors followed members for about a year after the switch to the high-deductible plan.

Patients under HDHP plans went to the emergency room 10 percent less than patients who remained in traditional plans. "Our study showed that for most members, the high-deductible plan seemed to work as intended," said Frank Wharam, MD, MPH, research fellow in the Department of Ambulatory Care and Prevention and the study's lead author. "Patients went to the emergency room less frequently for non-emergency conditions." The study found a 25 percent reduction in repeat visits, mostly for non-severe conditions.

Some studies were published this week in the Journal of the American Medical Association that should be of interest to anyone that doesn't have health insurance — or knows someone who is going without health insurance.

One of those new studies was by Jack Hadley from the Urban Institute, a nonpartisan research group based in Washington, D.C. He found that the major difference in healthcare Americans receive simply depends upon whether or not they have insurance.

"People who don't have health insurance run a serious risk of declining health should they have an accident or develop a chronic condition," said study author Hadley, from the Urban Institute, a nonpartisan research group based in Washington, D.C. "There is a real difference between people with insurance and without insurance in terms of what happens to them when they get sick."

Meanwhile, another study is finding that high-deductible health plans are actually reducing unnecessary hospitalizations.

"Emergency room visits were cut by about 10 percent compared with patients in traditional plans," said lead author Dr. J. Frank Wharam, of the department of ambulatory care and prevention at Harvard Medical School. "This is because these patients stopped going to the emergency room for problems such as colds, headaches, nausea and back pain."

The studies demonstrate the positives that HDHP plans deliver for consumers and the health system as a whole. Part of what is leading to burgeoning healthcare prices is abuse of the system — using emergency rooms to treat colds, for instance. HDHP plans discourage this kind of abuse. Meanwhile, HDHP plans are making health insurance more affordable. If you've perused Vimo's health insurance shopping engine, you'll notice that despite the rising premiums the health insurance industry is delivering customers for their 'gold plated' plans, high-deductible plans are quite affordable. And if used with an HSA they can make that "difference" between the insured and uninsured.