Preventive medicine: A cure for the healthcare crisis

Introductory Editorial: Few would dispute the premise that prevention, early detection, and early intervention form the first line of defense on the disease management (DM) continuum. That being the case, our national statistics on preventive health should be raising concerns throughout the industry. The US healthcare delivery system continues to fall woefully short of its prevention targets. On the international scene, the United States lags behind countries with less wealth and less technological savvy. Commentaries abound on the problems, but recently I became aware of an organization with an exciting goal and a novel solution for bringing preventive medicine into the mainstream. U.S. Preventive Medicine, Inc. (USPM) was founded by Christopher Fey, a former president and CEO of HealthCare USA, a multistate health maintenance organization, and senior officer of Coventry Health Care Corporation. A number of years ago, Mr. Fey had a life-altering experience. He witnessed his brother-in-law, a 39-year-old man in seemingly excellent physical condition, suffer a massive stroke that resulted in permanent right-sided paralysis, and speech and memory impairment. Following the event, physicians concluded that his brother-in-law’s risk factors could have been identified and his disease state detected by means of available technological screening devices. His was a condition for which effective drug therapy and other interventions were available. This event and its consequences were preventable. Having experienced firsthand the devastating consequences of a broken system that fails to respond until a condition produces symptoms, Mr. Fey became an evangelist for prevention and early detection. In founding USPM, he translated an interesting concept into an innovative model for preventive health in a consumer-driven market. In the following pages we provide a brief history of and current status report on the state of preventive health in the United States, and we present an overview of this company’s solution as one example of the untapped potential for innovation in the delivery of preventive services. I hope that the information contained herein will inspire you and our colleagues to join the conversation about the direction the United States will take with regard to improving access to screening and preventive services and enriching the lives of all citizens. As always, I welcome your comments. I can be reached at [email protected]

Report on the U.S. summit: Chronic care at the crossroads: Exploring solutions for chronic care management

On Tuesday, July 17, 2007 in Washington, DC, Intel Corporation assembled a group of the nation’s most respected health leaders to discuss the issues surrounding chronic care and an aging population and explore solutions to these highly complex and increasingly urgent challenges for the US health care system. The highlevel summit, hosted by Intel Chairman Craig Barrett, was held in the auditorium of the National Museum for Women in the Arts and attended, either in person or via the simultaneous webcast, by presidents, chairmen, and executive directors of influential organizations including the National Business Coalition on Health, the National Medical Association, and the Centers for Medicare and Medicaid Services (CMS). The summit was organized around 3 expert panels with representation from health care associations, health insurance companies, policy makers, advocates, providers and provider organizations, patient advocacy groups, and health technologies. Susan Dentzer, PBS\u27 on-air health correspondent (The NewsHour with Jim Lehrer), served as moderator. Highlights of the panel discussions follow

The effectiveness of heart failure disease management: Initial findings from a comprehensive program

A prevalent, chronic condition among members of the mushrooming elderly population in the United States, heart failure (HF) is a logical focus for population-based disease management. Evidence supporting the premise that multidisciplinary interventions can significantly improve clinical outcomes while decreasing the cost of medical care for people with HF is steadily mounting. A growing number of controlled and observational studies focus on the effects of HF disease management on re-admission rates, length of stay, and improvement in appropriate diagnostic testing and prescribing. This paper describes a large-scale, comprehensive HF program and reports on clinical quality, utilization, and financial outcomes observed after 1 year. The preliminary findings strengthen the case for comprehensive HF disease management as an effective means for improving clinical outcomes and reducing total medical costs for large patient populations

Improving Health Outcomes for Patients with Depression: A Population Health Imperative. Report on an Expert Panel Meeting

Improving Health Outcomes for Patients with Depression: A Population Health Imperative. Report on an Expert Panel Meeting Janice L. Clarke, RN, Alexis Skoufalos, EdD, Alice Medalia, PhD, and A. Mark Fendrick, MD Editorial: A Call to Action: David B. Nash, MD, MBA???S-2 Overview: Depression and the Population Health Imperative???S-3 Promoting Awareness of the Issues and Opportunities for Improvement???S-5 Cognitive Dysfunction in Affective Disorders???S-5 Critical Role of Employers in Improving Health Outcomes for Employees with Depression???S-6 Closing the Behavioral Health Professional and Process Gaps???S-6 Achieving the Triple Aim for Patients with Depressive Disorders???S-6 Improving the Experience of Care for Patients with Depression???S-6 Improving Quality of Care and Health Outcomes for Patients with Depression???S-7 Changing the Cost of Care Discussion from How Much to How Well???S-8 Panel Insights and Recommendations???S-9 Conclusion???S-10Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140195/1/pop.2016.0114.pd

The patient burden of screening mammography recall.

OBJECTIVE: The aim of this article is to evaluate the burden of direct and indirect costs borne by recalled patients after a false positive screening mammogram. METHODS: Women aged 40-75 years undergoing screening mammography were identified from a U.S. commercial claims database. Women were required to have 12 months pre- and 6 months post-index enrollment to identify utilization and exclude patients with subsequent cancer diagnoses. Recall was defined as the use of diagnostic mammography or breast ultrasound during 6 months post-index. Descriptive statistics were presented for recalled and non-recalled patients; differences were compared using the chi square test. Out-of-pocket costs were totaled by utilization type and in aggregate for all recall utilization. RESULTS: Of 1,723,139 patients with a mammography screening that were not diagnosed with breast cancer, 259,028 (15.0%) were recalled. Significant demographic differences were observed between recalled and non-recalled patients. The strongest drivers of patient costs were image-guided biopsy (mean $351 among 11.8$50; 80.1%), and ultrasound ($58; 65.7%), which accounted for 29.9%, 29.0%, and 27.5% of total recall costs, respectively. For many patients the entire cost of recall utilization was covered by the health plan. Total costs were substantially greater among patients with biopsy; one-third of all patients experienced multiple days of recall utilization. CONCLUSION: After a false positive screening mammography, recalled women incurred both direct medical costs and indirect time costs. The cost burden for women with employer-based insurance was dependent upon the type of utilization and extent of health plan coverage. Additional research and technologies are needed to address the entirety of the recall burden in diverse populations of women