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The Opioid Epidemic: Reason for Optimism
Posted By Louise Probst, Thursday, February 16, 2017
Recently, I participated in the BHC Pharmacy Management Initiative's fascinating forum on the Opioid Epidemic. We all know opioid misuse weighs heavily on American society, as the statistics in the text box to the left demonstrate.
 
But there is good news. Each speaker offered new and meaningful solutions. Here are some highlights: 
1) The Centers for Medicare and Medicaid Services (CMS) has evaluated and tested interventions to reduce the hazards of opioid use among Medicare enrollees. They now mandate a maximum opioid dose per month. The use of a standard calculation which converts all opioids prescribed to a Morphine Equivalent Dose (MED) has made this possible. In any given month, when a prescription exceeds this amount, the patient encounters a "hard stop" at the pharmacy. Alerts are also provided. Of course, hospice care and certain diagnoses exempt a patient from this safeguard. Medicare's early results warrant your consideration - so ask your health plan or PBM about a prior authorization for the MED.

2) Congratulations to the St. Louis County Department of Public Health for getting St. Louis County's Prescription Drug Monitoring Program (PDMP) organized so quickly and thoughtfully. It will go live in April and was developed to easily enable other municipalities to participate. Seven are already working together. At the outset, the program will cover a large portion of Missouri. The County appreciates the wide business and public support it has received and welcomes your help in spreading physician awareness of this coming resource. 

3) Dr. Michael Bottros of Washington University's Pain Management Center underscored that overprescribing and misuse of prescribed opioid medications are major sources of this problem. You might think that as a pain management physician specialist, opioid use would be higher in his patient population. I did, and I was wrong. A fairly small portion of his patients use these medicines. I also learned that for 1 out of every 5 patients undergoing a knee replacement, their joint pain continues after surgery. The good news is that there are many effective alternatives and more coming. New neurological interventions to control pain can help patients manage back, joint, and other pain. 

Meeting slides can be found here and more details are available from local expert and BHC Product Manager, Dave Heaton. 

Warm regards,

Louise Probst
BHC Executive Director


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Patient Choice of Surgeon or Hospital: Does it Really Matter?
Posted By Louise Probst, Thursday, February 16, 2017
The BHC's member meeting conversation last December focused on information from two national organizations that had boldly and publicly reported performance ratings for surgeons: Propublica and Consumers' Checkbook. Their analyses were based on millions of Medicare claims and both showed large differences in patient outcomes across individual surgeons.  
 
As a reminder, for total hip and knee replacements, where death is a rare occurrence, Consumers' Checkbook reported the best surgeons had overall bad-outcome rates (deaths, complications, and readmissions) of less than 8 percent, while the worst-performing one-tenth had overall bad-outcome rates of more than 21 percent.
 
Recently, researchers from the Harvard T.H. Chan School of Public Health asked: Do patients who receive care at a high quality hospital spend less? Using Medicare claims data to assess 90-day episode cost for five major surgical procedures, which included hip replacement, their answer was "yes". Superior surgical quality translates into lower mortality, higher patient satisfaction, fewer readmissions, and lower Medicare spending on post-acute care. 
 
Two common measures of surgical quality were assessed: 30-day surgical mortality rates and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.
 
Patients who had surgery, which included hip replacement, at high-quality hospitals cost Medicare less than those who had surgery at low-quality hospitals. Adjusted spending differences of nearly $2,700 in the first 30 days of care were found to be largely driven by the cost of care in the weeks following surgery. 
 
Interested in helping your employees use information to find better value care? The BHC can help - just give Patti or Louise a call at 314-721-7800.  
 
Warm regards,
Louise Probst
BHC Executive Director

 

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Rides to Wellness: Connecting Public Transit Users to Needed Health Care
Posted By Louise Probst, Thursday, February 16, 2017
The BHC congratulates two member companies on their successful new partnership. Bi-State Development Research Institute and the St. Louis County Department of Public Health recently received recognition and funds to help North County Metro riders assess and manage their health risks.
 
The Federal Transit Administration (FTA) has awarded $940,000 to Bi-State Development Research Institute to fund innovative mobile wellness units. Working in partnership with St. Louis County Department of Public Health, the program will improve access to vital sign monitoring and basic health screenings for residents dependent on public transit and living near several MetroLink Stations in North St. Louis County. Participating transit users will have the opportunity to receive onsite counseling based on screening results, in addition to being connected to health department clinics for follow up appointments. The mobile wellness units will be available at the North Hanley MetroLink Station, the Rock Road MetroLink Station, and the Wellston MetroLink Station.
 
The federal grant is part of the FTA's Rides to Wellness initiative, which emphasizes public transportation as a strategy for people to access non-emergency health care, resulting in better health, fewer hospital visits, and lower costs. The initiative focuses on improving the health of those with chronic conditions and ensuring that at-risk populations can get to wellnes appointments and obtain health screenings (such as blood pressure and cholesterol tests) and community services.
 
Demand for the U.S. Department of Transportation's FTA Rides to Wellness grants exceeded available funds, as 78 applications totaling $28 million from 34 states were received. The FTA awarded 19 projects in 16 states and only one in Missouri.
 
Let's wish them great success!
Warm regards,
Louise Probst

BHC Executive Director

 

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