Patient Care: A Healthy Debate

A lot has been made of the recent U.S. Preventative Services Task Force (USPSTF) report (http://www.ahrq.gov/clinic/uspstf09/breastcancer/brcanrs.htm#needs) on the role, expectations and outcomes of mammography screening in the determination of the presence of breast cancer. Here are the actual excerpts from the report that the media reacted to:

“In 2002, USPSTF concluded that there was fair evidence that mammography screening every 12 to 33 months could significantly reduce breast cancer mortality. The evidence was strongest for women aged 50 to 69 years, with weaker evidence supporting mammography screening for women aged 40 to 49 years.”

“Current knowledge about the development of breast cancer is limited. The effectiveness of screening mammography seen in trials presumably results from the early detection of smaller, earlier-stage tumors, which are more responsive to available treatments. Although the most common breast cancer occurs in the epithelial cells that line the duct system of the gland (ductal carcinoma), the sequence of development of invasive cancer is not entirely known.”

“The USPSTF noted with moderate certainty that the net benefits of screening mammography in women aged 50 to 74 years were at least moderate, and that the greatest benefits were seen in women aged 60 to 69 years. For women aged 40 to 49 years, the USPSTF had moderate certainty that the net benefits were small. Because of the uncertainties related to harms of screening, particularly over diagnosis, and the near total lack of trial data for older women, the USPSTF had low certainty about the net benefits of screening mammography for women 75 years or older.”

Patient care should never be compromised. Given the attention that Health Care reform has generated, any news is viewed good and bad based on the reader and interpretation.

The bottom line is that advancements in technology, research and education, not specific to any issue, or disease, has allowed for greater practicality in administering invasive tests. All progress is positive and debate is healthy.

-------------------------------------------------------------------------------------------

Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

AHIP Fall Forum

While Health Care remains top of mind for everyone in the US, the AHIP Fall Forum provided opportunity to learn and review what policies will make a difference in reducing costs and improving service in the system.

Over the next few weeks we'll be discussing the most relevant of those opportunities. Including how private plans can benefit from what the public option is proposing.

For now, we want to reinforce the importance of knowing the demographics of your plan members, and treating them uniquely based on the profile that provides.

Data continues to be the best friend a Health Care provider has in managing and reducing the overall costs in the system.

-------------------------------------------------------------------------------------------

Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Wellness: Measurement Shows Improved Health

In a recent article from Anne Zieger in Fierce Healthcare, she highlighted that private insurance plans have begun the debate over how effective employee wellness programs really are. And on the flip side, that large insurance plans haven't invested in the area heavily enough to have an impact, or measured to see any results.

While the debate rolls on with the insurers, Zieger goes on to point out that Emory University has been at work to see if the results are there.

According to the study conducted by Woodruff Health Sciences at Emory, measurable results were found in employee absenteeism (down 3.9 days in 2006 to 3.4 days in 2007 - 1.5 days lower than at standard sites).

This netted a savings of about $414.90 per employee per year, according to the study.

Our Take:

Results are found only when measured. Moving from discussion to action is critical for private insurance plans and measurement needs to be implemented by insurers across all types of coverage.

-------------------------------------------------------------------------------------------

Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.