Health Care Happenings

It is no secret that the cost of pharmaceuticals in our country has been one of the leading drivers of increased healthcare costs.  This is also true in the military’s healthcare system (MHS).

With the increasing emphasis placed on DoD to drive down costs, the MHS as a large portion of defense spending continues to be placed under tremendous scruitiny.  As the MOAA healthcare specialists, one of our roles is to participate with the TRICARE Management Activity’s (TMA) beneficiary coalition to partner in efforts to help address the escalating costs of healthcare.  We are presently fully engaged in this effort by developing strategies which will reduce the overall cost of pharmaceutical delivery.

One of the objectives we are actively participating in is in the area of mail order or home delivery of medications.  Our main goal is to influence beneficiaries and medication prescribers to increase their utilization of the mail order pharmacy option.

Consider this cost breakdown - for a 90 day supply of the top 500 brand medications the cost per perscription are as follows:  The military pharmacy = $117.00   Mail order =$169.00  and Retail (eg. a CVS, Walgreen’s etc) =$294.00!  As we can see, it is quite expensive to deliver medications through the retail system.  As of today’s date, of all pharmacy program prescription claim volumes only 30% are attributable to the mail order option.  This is where our our big opportunities lie!  By driving pharmacy refill medications away from the retail sector and into the mail order system, this has the potential to save millions of dollars in costs to the MHS!

Clearly the key to major cost avoidance is to optimize the home delivery experience.  The MHS has a contract to do this with a nationally renowned company within the industry named Express Scripts.  Express Scripts in partnership with the MHS and many of us beneficiary organizations, is putting together a plan to achieve increasingly significant conversion rates from predominantly the retail sector but also including the military pharmacies into the mail order system.

You will see soon, if you have not already, an increase in promotional materials and services which are designed to make this process extremely easy for you and I.  Next time you need to renew and refill a maintenance prescription, choose the home delivery option!

Here’s a question to consider — How much confidence do you have in Congress?

There’s been a lot happening on Capitol Hill these last couple of years. The down turn in the economy, industry bailouts, passing of national health care reform, and rise in unemployment, always looming Medicare/TRICARE doctor payment cuts and the list just goes on.

Gallup just released its 2010 Confidence in Institutions poll and finds Congress comes in last place — yes, you heard right, that’s last place out of 16 institutions.

The poll (Congress Ranks Last in Confidence in Institutions) showed:

11% of Americans say they have a ‘great deal or quite a lot’ of confidence in Congress. (Last year’s rating was 17%)”

…Underscoring Congress’ image problem, half of Americans now say they have ‘very little’ or ‘no’ confidence in Congress, up from 38% in 2009.”

The Military continues to rank highest of all institutions, a trend that goes back to 1998. The institution has been #1 or #2 since the poll began in 1975.

Americans ranked Small Business #2 and the Police as #3.

The Medical System came in at #5, four points higher than last year.

Just slightly behind Congress were Health Maintenance Organizations (HMOs), coming in next-to-last place at a 19% confidence rating, one percent higher than the year before.

So, what do you think about Congress?

Imagine if you will, a time where an appliance or gadget tells you it’s time to exercise, or that you are taking in too many calories, or warns you that your stress level is too high and it’s time to do something about it.

We see smart phone technology evolving beyond just making a mere phone call, to being a device or a gadget increasingly integrated into our daily lives—to some, we can’t live without them.

“Within a decade or two, researchers at Silicon Valley companies and elsewhere predict, consumer gadgets will be functioning like hyper-attentive butlers, anticipating and fulfilling people’s needs without having to be told. Life would not only be more convenient, it might even last longer: Devices could monitor people’s health and step in when needed to help them get better, states The Seattle Times article titled, Smart gadgets may anticipate our needs?”

Humm, I vaguely remember this being said about technology simplifying our lives decades ago—saying something like technology will give us more time to do the things we want.

Are you like me and waiting for that to happen too?

There are those who say these smart gadgets will be able to read people’s emotions, mood swings, or that household appliances will have humanlike personalities—maybe even serving as ‘artificial companions’ for elderly and lonely people.

Certainly the proliferation of computerized devices is exploding in the health care industry, like in other markets. The article discusses one initial application of the technology will likely be monitoring the elderly in their homes.

Researchers say they are already applying the technology in smart pill containers to detect the onset of dementia—the container records whether the person is taking their medication and has motion sensors that check if the individual’s walking and dressing habits have slowed down (potential early signs of the condition).

The military is even eyeing the possibilities of such technologies—

“assistants for commanders that can reason, learn from experience, be told what to do, explain what they are doing, reflect on their experience and respond robustly to surprise,” states the article.

Experts say smart houses with these devices, smart companions and other applications still have a ways to go before all the bugs are worked out. But, gee, we can dream can’t we?

Then there is always a down side to every up side.

There are some who have concerns about protecting the privacy of information that will be collected on individuals—fearful that the more data collected on people the more the government will want the information.

Oh yes, then there are those who wish to get their hands on the personal information so they can make a profit at someone else’s expense.

Lots to ponder!

              Are we smart or what–isn’t technology great?

What do you think—what a smart house or smart companion?

This past Friday, I had the opportunity to attend the official dedication and opening of the National Intrepid Center of Excellence (NICoE) on the campus of the current National Naval Medical Center in Bethesda MD.
And what a truly fantastic facility this is!

This new facility is now the nation’s foremost facility for research, diagnosis and treatment of traumatic brain injury (TBI) and post traumatic stress (PTS), conditions which afflict thousands of our nation’s military personnel and veterans. This center joins the existing Center for the Intrepid, which is also a world class state-of-the-art center located at Brooke Army Medical Center in San Antonio Texas.

The NICoE is a model of public-private partnership and was completed on time (actually a bit early..) and on-budget. It cost nearly $60 million to design, build and equip and every cent came from gifts from the general public. It’s progress and development was overseen by the Board of Trustee’s of the Intrepid Fallen Heroes Fund.

This center is architecturally unique and promotes a wellness and healing environment due to its use of windows which incorporates an indoor-outdoor atmosphere. Most importantly, NICoE has been specifically designed to meet the needs of our injured heroes. Its rooms, labs and open spaces are warm and inviting. The diagnosis and treatment equipment represents the latest advances in care, and the progress made in this Center will lead to further improvements in diagnosis and treatment. In addition, NICoE will incorporate families into the treatment process, which is key to the care that will be provided.

The location of the Center plays an important role. The proximity of it will foster partnerships with the National Institues of Health, the Uniformed Services University of the Health Sciences and the Department of Veterans Affairs. Employing a “center of centers” concept, NICoE will further leverage the distinguished expertise of four established centers within the Department of Defense: the Defense Veterans Brain Injury Center; the Center for the Study of Traumatic Stress; the Deployment Health Clinical Center; and the Center for Deployment Psychology.

We at MOAA look forward to the progress and the outcomes research which will be generated by this outstanding Center ~ The National Intrepid Center of Excellence for Psychological Health and Traumatic Brain Injury, which will address the needs of the men and women who have recieved these injuries serving our nation.

The doc’s are weighing in heavily on the impending 21% cut in Medicare payments. Many of us have experienced the message effects of the American Medical Association’s (AMA) multi-million dollar advertising campaign featured in full page adds in most of the major newspapers in this country, as well as on television and radio. The message is abundently clear in its criticism of the Senate for adjourning for its Memorial Day recess without acting to cancel the reimbursement cut.

As of the time of this blog writing, the Senate is not expected to hold any votes until next week. Even then it is unclear what action the Senate will ultimately take on this particurlar issue. It will prove extremely difficult to pass a payment fix over a year in length as there is no way to pay for it now. Thus, we may very well be in for a series of month to month fixes.

What does this mean for many of our doctors in practice and also for many of us - the patients who recieve our care from these doctors? - Remember, TRICARE reimbursement is tied to Medicare’s rate of doctor reimbursement for services, so many of our military families and retiree’s are at risk as well as our age 65 and over members.

The AMA just released a survey of over 9,000 doctors who take care of Medicare patients. Based on this they confirm that beneficiaries are being hurt by Congress’s failure to fix the physician payment system.

The survey found that 17% of doctors said they have been forced to limit the number of Medicare patients in their practice. Nearly one-third of primary care physicians have been forced to take that action, the survey found.

“The top two reasons physicians gave for these actions were the ongoing threat of future cuts and the fact that Medicare payment rates were already too low,” again according to the AMA.

This becomes more than concerning when you view many physicians practices as a “small business”. Which is really what they are and it becomes quite simply an issue of cash-flow. This reimbursement problem creates payment instability and is forcing some doctors to cut their staffs, take out loans, and defer payments on equipment. It also makes it very difficult for them to purchase the equipment for health reform’s requirement’s in the area of health technology. Think electronic medical records.

We at MOAA continue to watch these developments closely. We ask you to let us know if you experience access problems with your doctor as a result of this reimbursement issue.

Older veterans who suffer from posttraumatic stress disorder (PTSD) are almost twice as likely to develop Alzheimer’s disease and other age-related dementias as veterans without PTSD…”

…So says a study funded by the Department of Defense and the National Institute on Aging—the first ever to link combat related PTSD to dementia in older veterans.

It’s not clear from the study findings if having PTSD increases the risk of dementia later in life or whether recurring PTSD is an early symptom of the condition in older veterans.

The study can’t say specifically that PTSD causes dementia as one of the researchers points out…

                …….       But if it does, one theory is that stress is to blame, states the  WebMD Health News article entitled,

Study Shows Veterans With PTSD More Likely to Develop Alzheimer’s Later In Life.”

There is evidence however that chronic stress can cause damage to the brain where critical memory and learning takes place.

Here are the basic facts from the study:

• Followed 180,000 older veterans, mostly male, over a 7-year period
  53,000 were diagnosed with PTSD
• None had dementia in late 2000, but by 2007, 17% had been diagnosed with degenerative memory and thinking disorder
• Veterans with PTSD had about an 11% risk of developing dementia during the 7-year period, unlike those without the stress disorder

The findings seem pretty interesting and a lot scary to me.

Would love to hear your reactions to the article.

…………………What’s your take? ……………………..