'OTC shopping bonanza'

Starting January 1, 2011, certain categories of over-the-counter (OTC) drugs and medicines will require a prescription in order to get reimbursed through an FSA, HRA, or HSA plan. The change is due to legislation passed within the Health Care Reform.

A major motivator for this was that people with FAS were going on 'OTC shopping bonanzas' at the end of each year, stockpiling OTCs, buying them for friends and family, reselling them, etc.

Not sure adding this to the physician burden was the best solution, but there clearly was a problem that needed to be addressed.

Blog post here


An April 2010 analysis by consultancy Hewitt Associates drew on the firm's database of more than 220 U.S. employers covering more than 6 million employees. Among the findings:

• Only 20 percent of U.S. employees contributed to an FSA (flexible-spending account) in 2010
• Employees who participate typically save between $250 and $640 each year in federal taxes
• Around 7 percent of all FSA claims in 2009 were for OTC drugs

Mail-order meds

Mail-order meds must be doing a roaring trade in the U.K. to warrant this campaign:

More than one in seven British adults surveyed (15%) admitted to bypassing the healthcare system to get hold of prescription only medicine without a prescription, a practice which 78% of GPs surveyed say is putting people's health and potentially lives at risk as some of the medicines obtained in this way may be counterfeit.

Site here

Uninsured? Invest in health funds

There's an estimated 15.7 million adults under age 65 receiving coverage through an individual policy (as of 2008). I'm surprised there aren't more sophisticated funds to help individuals cover medical expenses - as described by the respondent below:

Comment on WSJ.com:

"I don't have [health insurance] because I am in good health and the cost is prohibitive. But I do take what it would cost for insurance and put it in a mutual fund and use this fund to pay my medical expenses. I get a 10-50% discount from medical providers for paying cash."

Based on article here

Doctor [can't] know best

People with multiple health problems (multimorbidity) are largely overlooked both in medical research and in the nation’s clinics and hospitals. The default position is to treat complicated patients as collections of malfunctioning body parts rather than as whole human beings.

As social networks let us keep an albeit shallow but consistent connection with those as various degrees of closeness to us, why wouldn't an physician-only social network (EMR bolt-on?) go a long way towards giving doctors the holistic view of their increasingly complex patients' cases?

Step up Facebook.

“Good luck and a lot of sleuthing on my part have given me doctors whom I trust and who are mostly aware of interactions among the drugs they prescribe, but what’s missing is someone who can look at the big picture and see my health as a whole"

“That falls to me alone, with the help of my very wise wife and frequent visits to reliable Web sites. As our population ages, we need some kind of overseer to juggle all the diagnoses and prescriptions and look for conflicts and duplications. This would also help to counteract the notion in many people’s minds that the doctor knows best — because often the doctor doesn’t.”

• Two-thirds of people over age 65, and almost three-quarters of people over 80, have multiple chronic health conditions.
• 68 percent of Medicare spending goes to people who have five or more chronic diseases.

Full article here

20th century comms. for 21st century docs.

As some of the physicians responding a WSJ.com article (link below), there are various factors for not emailing with patients but as new healthcare models such as HelloHealth show, there can be huge upsides too.

Prediction: Gmail-Google Health and Hotmail-MS Healthvault will bring HIPPA-compliant, patient/doctor communications to the U.S. in the near future.

Now we just need to work out how physicians will get reimbursed for giving care via email?

Comments on WSJ:

"The major disadvantage of email and one reason I try to avoid it with my patients is that it does NOT become part of the medical record so covering physicians have no access to it and creates a silo of information not readily available."

"Hippa violation, no reimbursement, increased risk. Done."

"I don’t e-mail patients because I need to ask more than 1 question and it is much faster to speak than type. Plus I need context and tone to interpret content. I have seen far too many misunderstandings with e-mail."

According to the Center for Studying Health System Change, only 6.7% of the 4,200-plus office-based physicians who responded to a 2008 national survey “routinely” emailed patients about clinical matters. Most just didn’t have the technology available, but even among the doctors who had email access, only 19.5% regularly emailed with patients.

Full article here

Loyal to your health

Haven't these guys cracked the non-adherence code? Exciting stuff - definitely one to watch.

Get paid to take your meds with Health Prize:

Non-adherence stats

- The New England Healthcare Institute estimates that medication non-adherence is responsible for approximately $290 billion of “otherwise avoidable medical spending” each year in the US

- 25-30% of all new scripts are never filled – whether the script is for a drug that can improve your life or save it

- Even serious medical conditions that could cause significant negative outcomes, including death, are not enough to get people to adhere to their medications – recent studies have shown that transplant patients are only around 70% adherent to the medications they need to ensure they do not reject their transplanted organs

Bizarre irrationality = humanness

It's time for we, in the business of healthcare communications, to delve deeper into patients' realities and embrace the irrational.

A recent study commissioned by CVS Caremark, delved deeper into the minds of patients who stopped taking their prescription medications. An impressive percentage of patients gave bizarre reasons for stopping their meds, like that taking medication:

“Interfered with personal priorities such as taking care of family members”

“Compromised social aspects of their lives”

“Made them feel like they were losing control of their lives and sometimes by stopping medication they felt they were resisting authority”

“Believed they knew better than their doctors what was good for them”

Key lesson: there is often an irrational (human) reason behind non-compliance. So, interventions that appeal purely to the rational side of human beings, like reminders or education, will only go so far.

Tweet what you eat

It does what it says, although this system is intelligent on the back end. Gone are the days we have to count calories. All we have to do now is tweet the foods we eat on a daily basis, and the website will tally up our daily calories for us based on inputted ingredient data, and crowd-sourced information.

http://www.tweetwhatyoueat.com/

When patients take the reins, what role for doctors?

“We have the ability to run a probability engine, we can mathematically model each patient. We can tell them what’s going to happen in their life. We can tell you when you’ll need a wheelchair. And we can even tell you the day you’ll die, with remarkable certainty.”

Jamie Heywood, PatientsLikeMe

Membership of PatientsLikeMe

(click to expand)

Infographic sourced here

Dx on Aggregate

A great example of how the most advanced computers in the world (i.e. human brains) connected through the second best (or second most complex) computing-network in the world, the web, can make a remarkable difference in quality of care:

"Sometime in 1995, an e-mail from China arrived in my inbox with a desperate request for medical advice. In broken English, the message described a 21-year-old woman who had felt sick to her stomach and within days lost all her hair. This problem went away, but a few months later, "She Began to facial paralysis, central muscle of eye's paralysis, self-controlled respiration disappeared," and needed to be put on a ventilator. "This is the first time that Chinese try to find help from Internet," the message explained. "Please send back e-mail to us." With immature confidence I consulted some texts and replied that maybe she had a weird form of lupus. I never heard back and figured it was a prank.

The following year at the supermarket, I was browsing the August issue of Reader's Digest and saw a piece titled "Rescue on the Internet." It turned out that I wasn't the only one who'd replied to the posting, and the whole thing had not been a hoax. Incredibly, hundreds of doctors had seen the brief message and correctly determined that the patient was being poisoned by a tasteless, odorless heavy metal called thallium. Soon after, Chinese doctors were able to give an antidote to save the woman's life. (She did end up permanently disabled.)

The Chinese e-mail episode shows how large groups of doctors might come together to solve a problem. More than 1,000 trained medical professionals independently guessed at the cause of the woman's illness, and while many were wrong, almost one-third suspected thallium poisoning. That was enough to get her doctors in China to consider the possibility and then confirm it."

Full article here

Stats re: patient ed. improving quality of care