Lessons from Medicare

Are disease management, patient education or value based payment cost efficient?

In the medicare experience results were mitigated and barely paid the program’s fees. You can read the brief that has been issued by the  Congressional Budget Office‘s health and Human Resources division:

Click to access 01-18-12-MedicareDemoBrief.pdf

and the blog that discusses the report:

Can the “Better Care, Lower Cost Act” live up to its name?

In France  a program of disease management and care coordination has been implemented. Its name is Sophia and it targets two chronic diseases, asthma and diabetes mellitus. More information here:

http://www.ameli-sophia.fr/le-service-sophia

But I can’t find any evaluation of the kind of the CBO report that searches if the health care cost savings, inherent to the program, balance the program’s fees. If you have found such a report let me know.

I’ll be back…

Everybody remember this legendary reply in the movie « Terminator”.

But what if the reply stands in the mouth of a Medicare enrolee being just discharged from a hospital stay?

These words are really frightening the federal administration.

According to a study published by the New England Journal of Medicine, 20 percent of patients could have pronounced leaving the hospital the same three scaring words as Schwartzy pronounced when leaving the police station.

With the new ACO (Accountable Care Organisations) hospitals could be held reliable from what happens to their patient after their discharge. In this model of health management some hospitals will employ primary care practitioners or nurses to follow the discharged patient when returning at home. Medicare could pay a single fee per patient to cover all the cares which are undertaken in and outside the four wall of the hospital.

Meanwhile Medicare think to penalize hospitals that present high readmission rates within the 30 days following discharge.

To restart insert $ 1 trillion

(thanks to this cartoon by Andy Davey from The Sun relates to the U.S. debt crisis)

A trillion is a million million, or one followed by 12 zeroes

The actual amount of the US debt is equal to  $14.3 trillion.

The responsibles are the wars that were undertaken by America, the tax cuts offered by Obama’s predecessor and  the costs of health care.

If the rising of the debt ceiling is not allowed by congress, America should have to cut in financing Medicaid and Medicare.

Health care providers depend heavily on Medicare and Medicaid programs. The federal government participates on average as high as 56 percent in Medicaid costs.

Already government and health policy stake-holders talk about rising the age of admission to Medicare from 65 to 67 years in order to save public spendings.

Judicial battle under Californian sun

Three Managed care companies Kaiser, Heritage and Medicare allege that an hospitals chain named Prime Health Care Services capture their enrolees in its emergency rooms and up-code their pathologies to admit them for a stay. At least that is what is reported by California Watch in its July 23 edition.

Prime’s billing practices are under investigation by The U.S. Department of Health and Human Services Office according to California Watch journalist.

Prime Health Care declares that these accusations are based on a deeply flawed analysis of biased statistical data on rates of patients admission that can be explained otherwise than for financial reasons. Primary Health Care CEO declares that California watch article is defamatory and that there is no federal investigation. He supposes that the journal is manipulated by an Union named Service Employees International Union (SEIU).

I make my mind that an other very good title for this post should had been: “Struggle among health provider, health insurers and union activists under Californian sun”.

They would better go to the beach wouldn’t they?