An Express Scripts survey finds a strong majority of people with chronic diseases want some sort of reward for staying on their medications.
Apparently, the prospect of improved health is not motivation enough to keep some people on their medications regimens.
A new survey from Express Scripts finds that strong majorities of people with chronic diseases want a reward for taking their medications.
Two-thirds of the 800 chronically ill adults polled say they are more likely to take better care of their health and adhere to their medications when rewarded for their efforts. Those numbers vaulted to 88% for adults ages 18 - 34.
By some estimates, medication noncompliance costs about $300 billion each year in the form of increased downriver care costs, such as complications that require emergency department visits.
Given the potential savings and improved healthcare outcomes, and the popularity of rewards programs with patients, the idea is being vigorously pursued by Express Scripts, says Kyle Amelung, a senior clinical consultant with the company.
"We have seen this in healthcare in a number of different areas, particularly in wellness programs that incentivize people to stop smoking or exercise or be mindful of their health," Amelung says.
"We are taking it a step further," he says. "We want to reward people with chronic conditions for becoming more health literate. We want to reward them for tracking biometrics like blood pressure and blood glucose, and we want to reward them for sticking on their medication."
Personal financial rewards were cited as the overwhelming preference by 82% of respondents while charitable contributions were chosen by 3%.
"Behavioral science has shown us that incentives are the one thing that can increase this behavior," Amelung says. "Even if you showcase the possible negative outcomes that can occur from non-adherence, most people just aren't incentivized to take care of their health for one reason or another."
While he didn't provide specific numbers, Amelung says the rewards program, which is subsidized by fees charged to providers, is generating about $2 in savings for every $1 spent, a ratio they hope to improve upon.
Amelung says Express Scripts hasn't found a one-size-fits-all "silver bullet" approach to medication adherence, but a rewards program they've launched through its Mango Health app shows potential.
"About 80% of U.S. adults use a smart phone, so if we can use that to encouraged improved clinical behavior, and that is a win-win for everybody," Amelung says.
The app asks patients to report daily on key metrics, such as blood pressure or blood glucose, and in exchange they build up rewards points. Each week, there's a raffle with gift cards at retailers such as Starbucks, Amazon, and Whole Foods.
"This encourages people to go in there every day, state what their biometrics are, how adherent they are to their medications, and they can win these gift cards that are applicable to their daily lives," Amelung says.
While 60% of the patients who access Mango Health are aged 50 or older, Amelung says the app – and the rewards -- are particularly popular with younger adults.
"This younger generation has been on cell phones pretty much their entire lives and they understand the rewards that can come through them and how the technology can help them live a healthier lifestyle," he says.
The faith-based health system says the new names for its hospitals and other medical facilities "reflects our unity and organizational commitment to providing exceptional healthcare."
SSM Health in Oklahoma this week unveiled new, more uniformed signage at all of its healthcare facilities that more prominently displays the SSM Health affiliation.
"Our new name reflects our unity and organizational commitment to providing exceptional healthcare services, improving the lives of our patients and improving the health of our communities," the Oklahoma City-based, Catholic health system said in a media release.
Beginning this week, the hospitals, medical group and other facilities in Oklahoma will be known as:
SSM Health St. Anthony Hospital - Oklahoma City
SSM Health Bone & Joint Hospital at St. Anthony
SSM Health St. Anthony South
SSM Health St. Anthony Healthplex
SSM Health St. Anthony Hospital - Shawnee
SSM Health Medical Group
"For nearly 120 years, we have had the honor and privilege of serving patients in central Oklahoma and beyond," said Joe Hodges, regional president, SSM Health in Oklahoma.
"Today we are renewing our vow to this community and everyone we serve," he said. "While our look may be changing, we remain a Catholic health system dedicated to our Mission. Our commitment to provide an exceptional experience to every patient remains the same."
SSM Health said the signage transition will take a few months, but will have no effect on care delivery.
"Patients will see the same providers they have come to know and trust in the same locations they are familiar with," the health system said.
Physicians complain that a "severe delay" in updating the CMS Quality Payment Program interactive website, and other eligibility notification breakdowns have left them "in the dark on their status."
The American Medical Association and more than 40 physician specialty associations are calling for the federal government to reduce from one year to 90 days the reporting period for 2018 Merit-based Incentive Payment System.
In a letter to Centers for Medicare & Medicaid Services Administrator Seema Verma, the physicians' associations say the curtailed reporting period is needed because:
CMS failed to provide timely notification on physician eligibility for the program;
The agency's "severe delay" in updating its Quality Payment Program interactive website means it won't be ready this summer.
The physicians say that the modifications to the Medicare Access and CHIP Reauthorization Act under the Bipartisan Budget Act exclude Medicare Part B drug costs from MIPS payment adjustments. Because of that, physicians cannot rely on any previous "historic" estimates to determine if they're excluded under the low-volume threshold.
"Thus, despite being held accountable for data tracking and collection as of January 1, 2018, physicians were not informed of basic eligibility information until early April to determine whether they must participate in the MIPS program," the physicians told Verma.
"Furthermore, in order to determine whether they are eligible for the MIPS program, a physician must actively go on to CMS' website. Previously, CMS has mailed letters to practices to inform them of their eligibility status, which many practices were waiting on this year."
"Without direct outreach by CMS to physicians and group practices, many physicians will be left in the dark on their status," the letter said.
Executives at the Seattle-based health system say they are responding to requests for guidance from rural hospitals "who want a partner that understands their perspective."
Virginia Mason Medical Center in Seattle has formed a consulting group to help community and rural hospitals across a range of challenges.
The new affiliate, NetworxHealth, LLC, is a wholly-owned, for-profit affiliate of Virginia Mason Medical Center, and will provide guidance for boards of directors during transitions in C-level positions.
Consulting services will also include pharmacy operations, continuing medical education, financial management, supply chain efficiency, laboratory operations, group purchasing, facilities and construction project management, the company said in a media release.
"We provide executive and management placement and consulting services for any hospital or medical center in the nation – and we have a special focus on rural and community hospitals," said Noel Rea, MBA, senior director and hospital administrator.
"Rural providers have a unique role in the fabric of their communities as they serve their friends, families and neighbors," Rea says. "Small hospitals often are the cornerstone for the entire health delivery system in their communities. It is important to keep them vibrant, successful and independent."
Ken Freeman, president of Virginia Mason Health Resource Services, says the consulting group "is our response to independent and rural hospitals requesting support over the years."
"We consistently hear from organizations that want a partner that understands their perspective and will be supportive of their particular needs while maintaining local control," Freeman says.
The state-by-state, twice-yearly rankings from Leapfrog Group provide a snapshot of safety scores at approximately 2,500 acute-care hospitals across the United States.
New findings in a national study of hospital safety suggest that hospitals are reducing avoidable deaths from errors and infections.
The Leapfrog Group's bi-annual 2018 Leapfrog Hospital Safety Grades provides letter grades for thousands of general, acute-care hospitals across the United States, and found that:
Of the approximately 2,500 hospitals graded, 30% earned an "A," 28% earned a "B," 35% a "C," 6% a "D" and 1% an "F";
Hawaii's hospitals were ranked the safest in the nation in a state-by-state comparison, with 73% of the hospitals in the Aloha State earning an "A".
Alaska, Delaware, and North Dakota were in a three-way tie for last place, with none of their hospitals earning an "A" grade.
Five "A" hospitals receiving this grade for the very first time had an "F" grade in the past;
46 hospitals achieved an "A" for the first time since the Leapfrog grading began six years ago;
89 hospitals receiving an "A" at one point had received a "D" or "F";
Continued strong performance from states including Rhode Island, Hawaii, Wisconsin, and Idaho which once ranked near the bottom of the state rankings of percentage of "A" hospitals but now rank in the top 10;
49 hospitals nationwide have achieved an "A" in every grading update since the launch of the Safety Grade in spring 2012.
Kwampirs malware was found in software for X-Rays and MRIs, and targets older, legacy systems that are prevalent in the healthcare sector and which provide relatively easy access for the virus.
Hackers known as Orangeworm are installing a backdoor malware called Trojan.Kwampirs within large corporations in the healthcare sector in the United States, Europe, and Asia, the cyber-defense firm Symantec says.
"First identified in January 2015, Orangeworm has also conducted targeted attacks against organizations in related industries as part of a larger supply-chain attack in order to reach their intended victims," Symantec says in ablog post.
"Known victims include healthcare providers, pharmaceuticals, IT solution providers for healthcare and equipment manufacturers that serve the healthcare industry, likely for the purpose of corporate espionage," Symantec says.
Kwampirs was found on software used for X-Rays and MRIs, and the malware also targets systems used to assist patients in completing consent forms for required procedures.
Orangeworm's motives with the Kwampirs malware are not clear, but Symantec says it is likely the work of an individual or a small group of hackers, and the goal is corporate espionage.
Based on the list of known victims, Symantec says Orangeworm appears to choose its targets carefully and deliberately, conducting a good amount of planning before launching an attack.
According to Symantec telemetry, almost 40% of Orangeworm’s confirmed victim companies globally are in the healthcare industry. Of those healthcare companies, the biggest number of victims are in the United States, which accounts for 17% of infections.
Once Orangeworm has infiltrated a victim’s network, they deploy Trojan.Kwampirs, a backdoor Trojan that provides the attackers with remote access to the compromised computer, Symantec says.
"Once inside, Kwampirs decrypts and extracts a copy of its main DLL payload from its resource section. Before writing the payload to disk, it inserts a randomly generated string into the middle of the decrypted payload in an attempt to evade hash-based detections," Symantec says.
If Orangeworm determines that a victim is of interest, it aggressively copies the backdoor across open network shares to infect other computers.
The malware gathers as much information about the victim’s network as possible, including any information pertaining to recently accessed computers, network adapter information, available network shares, mapped drives, and files present on the compromised computer.
Symantec says that Kwampirs uses a fairly aggressive means to propagate itself once inside a victim's network by copying itself over network shares.
"While this method is considered somewhat old, it may still be viable for environments that run older operating systems such as Windows XP," Symantec says.
"This method has likely proved effective within the healthcare industry, which may run legacy systems on older platforms designed for the medical community. Older systems like Windows XP are much more likely to be prevalent within this industry."
The deal is subject to state regulatory approval, and comes as California officials are taking a keen interest in health industry consolidation, especially in the northern regions of the state.
California's Adventist Health and St. Joseph Health have agreed to integrate clinical services under a joint operating company, the two health systems announced Monday.
The partnership will extend to clinics and facilities owned by both religious nonprofit health systems in Humboldt, Mendocino, Sonoma, Lake, Napa, and Solano counties, subject to regulatory review.
Adventist Health and St. Joseph Health will retain existing hospital names, licenses, capital assets and employees. The two systems hope to have the deal finalized by the end of the year. Financial terms were not disclosed.
“Adventist Health and St. Joseph Health believe this is the right thing to do for the communities we serve,” Jeff Eller, Adventist Health president of the Northern California region, said in a media release.
“Patients will benefit from more access points, better health outcomes and controlled costs by coordinating their care across the spectrum of their health needs,” Eller said.
The affiliation applies to Adventist Health Howard Memorial, Adventist Health Ukiah Valley, Adventist Health Clear Lake, Adventist Health St. Helena and Adventist Health Vallejo and Home Health; and to St. Joseph Hospital Eureka, Redwood Memorial Hospital, Santa Rosa Memorial Hospital, Queen of the Valley Hospital and the St. Joseph Home Care Network.
The arrangement does not include the other 15 Adventist Health hospitals in the western United States or the other 50 Providence St. Joseph Health hospitals located throughout the western United States and Texas.
Last month, the California Attorney General’s Office filed suit against Sutter Health, alleging that the largest health system in Northern California is engaged in anticompetitive practices that are raising healthcare costs for consumers.
"Sutter Health is throwing its weight around in the healthcare market, engaging in illegal, anticompetitive pricing that hurts California families," California Attorney General Xavier Becerra said of the filing.
The AG’s complaint came shortly after a new report by University of California Berkeley’s Petris Center on Health Care Markets and Consumer Welfare that documents how the rapid consolidation of healthcare markets in California has led to rising healthcare costs for consumers throughout the state.
Sutter Health has called the attorney general's filing "factually inaccurate."
"It mischaracterizes the activities of our not-for-profit organization, and it fails to adequately account for Northern California’s robust and competitive health care environment," the health system said in prepared remarks.
The health insurance lobby says the duration of short-term plans should be extended no longer than six months, and that consumers should be clearly told the limits of their coverage.
The federal government's proposal to relax coverage requirements for 90-day, short-term health plans is getting a chilly reception from the health insurance industry.
America's Health Insurance Plans incoming President and CEO Matt Eyles told the Department of Health and Human Services that the short-term plans should not be offered as a full replacement for comprehensive coverage.
"We are concerned that substantially expanding access to short-term, limited duration insurance will negatively impact conditions in the individual health insurance market, exacerbating problems with access to affordable comprehensive coverage for all individual market consumers," Eyles saidin a letter to HHS Secretary Alex Azar.
Under the proposed rule, short-term insurance would not have to comply with coverage mandates under the Affordable Care Act, which include preexisting condition protections, preventive care, prescription drugs and mental health coverage. The proposed rule also eliminates the three-month limit on the duration of the plans.
Critics contendthat the restrictions on short-term plans were put in place to prevent health insurance companies from siphoning off healthy people at the expense of the more comprehensive, and expensive ACA-mandated options.
Eyles appeared to agree with many of the criticisms.
In his letter to Azar, Eyles said that the short-term plans should be extended no more than six months, and should provide consumers with clear disclosures about the extent of the coverage and the availability of more comprehensive coverage through the healthcare marketplace.
He also recommended that the rule change not go into effect before Jan. 1, 2020.
Earlier this month, the Alliance of Community Health Plans also raised concerns about the proposed rule in a letter to Centers for Medicare & Medicaid Administrator Seema Verma.
"With few advantages of short-term, limited duration insurance and the high risk of introducing additional instability in the small group and individual marketplaces, ACHP recommends that the Departments not finalize the proposed rule," ACHP President and CEO Ceci Connolly said in the letter.
"We suggest that other policy approaches, such as establishing a federal reinsurance program for the ACA-compliant individual and small group markets, would be far more effective in promoting affordable coverage options," Connolly said.
Patient factors associated with a lower use of opioids include older age, no history of anxiety, and lower pain scores at discharge. Researchers say one-size-fits-all opioid prescribing may not be in patients' best interest.
Nearly one-third of patients at three academic medical centers used none of the opioids they were prescribed after surgery, according to a survey byMayo Clinic.
Researchers surveyed 1,907 patients who underwent 25 common surgeries at three academic medical centers and found that:
At discharge, 92% of patients received an opioid prescription.
Of the opioids prescribed, 63% went unused.
90% of patients were satisfied with their pain control.
28% said they were prescribed too many opioids; 8% said they were prescribed too few.
The median amount of opioids consumed per patient equaled about six pills of 5-milligram oxycodone.
The number of opioids patients needed after discharge also varied significantly depending on the type of surgery.
"This research provides a road map for physicians and surgical departments. It shows there are certain surgeries and types of patients who are likely receiving significantly more opioids than needed," says study senior author Elizabeth Habermann.
Patient factors associated with a lower use of opioids include older age, no history of anxiety, and a lower pain score at discharge. Conversely, factors that could potentially predict the need for more opioids include those younger in age, a history of anxiety and a higher pain score at discharge.
"Opioid prescribing guidelines should be based on evidence, considering patient factors and the type of procedure, but also allowing for prescriber discretion," Habermann says.
"This research and numerous other opioid prescribing projects at Mayo Clinic are about identifying the best approach for each individual patient, whether that’s increasing, decreasing or maintaining prescription levels."
Habermann says one-size-fits-all maximums for opioid prescribing that are being advocated by many prescription drug plans and legislators to treat acute pain may not be in patients' best interest.
Carbon dioxide emissions generated by the healthcare system could play a role in approximately 20,000 premature deaths each year that are linked to air pollution.
The nation's $3.3 trillion healthcare system spews about 10% of the carbon dioxide generated in the United States each year, anew study from The Commonwealth Fund.
The U.S. healthcare system emitted 655 million metric tons of carbon dioxide in 2011, which accounted for around 10% of the CO2 generated in the United States that year.
By reducing carbon emissions and building infrastructure more resilient to natural disasters, The Commonwealth Fund says healthcare organizations can reduce their carbon footprint and improve health. Some providers are already taking action.
For example:
Kaiser Permanente has reduced greenhouse gas emissions by 29% while increasing membership by 20%. Kaiser projected its annual greenhouse gas emissions would decrease from 806,000 metric tons to 617,000 metric tons by 2017 as a result of clean-energy practices.
After a devastating storm in 2001 halted almost all operations at the Texas Medical Center, the organization rebuilt with a “hazard mitigation plan.” The center built its own new heat and power utility plant at an elevation to avoid flooding. The plant emits less carbon, and is managed by an independent power company, eliminating dependence on the Houston utility grid. When Hurricane Harvey hit, the medical center remained almost fully operational.
New York City’s Bellevue Hospital, which serves more than 500,000 patients annually, was forced to close temporarily and move patients when Hurricane Sandy struck in 2012. When it rebuilt, many of the replacements for flooded electrical and mechanical systems were positioned on higher floors, and the hospital’s emergency power system added a generator to reduce dependence on the city’s grid.
Partners HealthCare is developing a climate adaptation plan in partnership with the city of Boston. Partners recognized the vulnerability to climate change of its Spaulding Rehabilitation Hospital on Boston’s waterfront, and adopted a set of best practices to make the building more resilient to rising sea levels.
The Commonwealth Fund says health systems are beginning to see the value in reducing carbon emissions, and not just for the environment.
"This might not only reduce the cost of care — one of the biggest woes ailing the U.S. health system — but also help fulfill the obligations that come with the industry’s size, its huge carbon footprint, and its mission to improve health," the report said.
"Effective strategies for addressing climate change should become an essential attribute of high-performing health systems in the future."
