Finding their way home. Despite mixed evidence, providers and payers are adopting patient-centered medical homes to improve health and cut costs

Medical homes are proliferating, though not everyone is convinced they'll produce savings. Don't tell that to the Michigan Blues, which since 2008 has helped more than 1,200 primary-care practices qualify as medical homes, with another 1,000 in the process. The insurer calculates that the project saved it $155 million in 2012 alone. "Those are dollar savings observed in claims data--these are not back-of-the-envelope calculations," says Dr. David Share, of the Michigan Blues.

Private expenditures on brand name prescription drugs after generic entry

BACKGROUND

Generic drugs offer a less expensive and therapeutically equivalent alternative to brand name drugs. Nevertheless, many Canadian private drug plans continue to pay for brand name drugs even after generics become available.

OBJECTIVE

The objective of this study was to quantify the excess spending resulting from this practice.

METHODS

We used the IMS Brogan PharmaStat database to study private-plan drug spending in Ontario from 2000 to 2009. We focused on three widely used drug classes: proton pump inhibitors (PPIs), selective serotonin reuptake inhibitors (SSRIs), and angiotensin-converting enzyme (ACE) inhibitors. For each specific molecule, we determined the difference between what private plans spent on the brand name version and what would have been spent if an available generic version of the same molecule had been purchased instead.

RESULTS

We found that prescriptions paid for by private drug plans were often filled with brand name drugs after generics became available. This led to excess private spending of more than Can$107.8 million for these three drug classes over our study period: Can$54.4 million for PPIs, Can$32.4 million for SSRIs and Can$21.0 million for ACE inhibitors.

INTERPRETATION

Brand name drugs continue to be reimbursed by Canadian private drug plans at higher prices even after less expensive generic alternatives are available. By mandating generic substitution, substantial cost savings on benefit plans could be achieved.

Retrospective comparison of Traditional vs. LigaSure impact dissection during pancreatoduodenectomy: how to save money by using an expensive device

Pancreatoduodenectomy is an exceptional procedure that requires an extensive dissection of the supramesocolic region extended to the first jejunal limb. Lymphadenectomy, required for cancer, increases the dissection surface. The extensive preparation of the area is traditionally conducted with bipolar ormonopolar instruments, while clips, ligatures, and sutures are used for haemostasis. LigaSure™ vessel sealing(LSVS; Valleylab, Boulder, CO) is a technology that obtains vessel closure by using the body's own collagen and elastin to create a permanent fusion zone. This is obtained by a combination of forceps pressure and radio frequency. This effect has been improved by the introduction of the Force Triad™ (Valleylab, Boulder,CO) energy platform, controlled by TissueFect™ (Valleylab, Boulder, CO) sensing technology. With this device, the surgeon is able to fuse vessels up to 7 mm, lymphatics, tissue bundles, and pulmonary vasculature in a fast-seal cycle of almost 4 seconds. In our daily practice of open surgery we observe a rapid improvement of abdominal drainage output with a drastic reduction of protein loss. Its practical significance is, in our opinion, that we obtain a rapid recovery of normal serum protein levels with a low number of blood/plasmasac transfusions and a real improvement of anastomosis healing. Moreover, the efficacy and the speed of work of the device allow us to reduce the operating time significantly but safely. We performed a retrospective analysis of the data of 20 pancreatic resections conducted both with traditional dissection and with the Liga-Sure Impact device with Force Triad platform in order to verify whether observed data were real. Our clinical results show that the use of the LigaSure Impact device with Force Triad energy platform is really useful in open surgery to save operating time, number of postoperative days, and hemoderivate administration.

Hospital operations management: improving organizational efficiency

Reducing operational inefficiencies represents one of the most promising sources of potential savings in hospitals today. Health Forum convened a panel of hospital executives and industry experts to discuss the daunting challenges and big opportunities that lie ahead.

The impact of electronic health records on ambulatory costs among Medicaid beneficiaries

BACKGROUND

Broad adoption of electronic health records (EHRs) is a potential strategy for curbing healthcare cost growth, which is particularly vital for Medicaid. Despite limited evidence for EHR-related cost savings, the 2009 HITECH Act included incentives for providers to become meaningful users of EHRs. We evaluated a large Massachusetts EHR pilot to obtain early insight into the potential for the national strategy to reduce short-run healthcare costs in the Medicaid population.

METHODS

We calculated monthly ambulatory cost and visit measures from Medicaid claims data for beneficiaries receiving the majority of their care in the three Massachusetts eHealth Collaborative (MAeHC) pilot communities or in six matched control communities. Using a difference-in-differences of slope analysis, we assessed whether cost and visit trajectories differed in the pre-implementation period compared to the post-implementation period for intervention and control community members.

RESULTS

We found evidence that EHR adoption impacted ambulatory medical cost in two of the three communities, but the effects were in opposite directions. Ambulatory medical costs increased more slowly in one intervention compared to its control communities in the pre-to-post period (difference-in-differences=-1.98%, p<0.001; PMPM savings of $41.60). In contrast, for a second pilot community, ambulatory medical cost increased more slowly in the control communities (difference-in-differences=2.56%, p=0.005; PMPM increase of $43.34).

CONCLUSIONS

As a stand-alone approach, adoption of commercially-available EHRs in community practices did not consistently impact Medicaid costs in the short-run. This suggests that future meaningful use criteria may need to specifically target cost savings and coordinate with payment reform efforts.

Prevalence and related factors for choosing self-medication among pharmacies visitors based on health belief model in Hamadan Province, west of Iran

BACKGROUND

Self-medication has increased in the last decade in Iran; can be followed several complications. The aim of this study was to determine the prevalence and factors influencing self-medication based on health belief model.

METHODS

A cross-sectional study was conducted among 1400 Hamadan Province pharmacies visitors, during spring and summer 2012 which was randomly selected with the proportional to size among different pharmacy at Hamadan for participation in this study. A structured questionnaire was applied for collecting data, which were analyzed by SPSS version 16 using bivariate correlations and logistic regression statistical tests.

RESULTS

35.4% of the participants had self-medication. Pain medication (10.6%), antibiotics (7.3%) and anti-cough and cold medications (4.5%) had the largest consumption. The main reasons of self-medication among participants were previous use of medication, symptoms improve and similar prescribed. The best predictor for self-medication was perceived severity with odds ratio estimate of 0.790 [95% CI: 0.694, 0.900].

CONCLUSION

It seems that designing and implementation of educational programs to increase seriousness about side effect of self-medication may be usefulness of the results in order to prevent of self-medication.