Entries in Surveys & Reports (83)

Friday
May152015

Patient Reported Outcomes

By Clive Riddle, May 15, 2015

The National Quality Forum defines Patient-Reported Outcomes (PROs) as "any report of the status of a patient's health condition that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else." They elaborate that “in other words, PRO tools measure what patients are able to do and how they feel by asking questions. These tools enable assessment of patient–reported health status for physical, mental, and social well–being.”

The concept is obviously not new, but has certainly been overlooked at times. In an era with tremendous advances and emphasis in patient engagement, mobile health technologies, patient-centered care, we need to continue to see application of PROs receive the attention they deserve.

Dr. Bruce Feinberg, vice president and chief medical officer of Cardinal Health Specialty Solutions, tells us "As our healthcare system moves toward a value-based care model, the role of the patient is becoming increasingly important. We need to reframe the way we think about care to include not only the cost and clinical effectiveness of the treatment, but also the burden of disease and therapy on the patient's perceived sense of well-being. Patient-reported outcomes (PRO) are key to this equation, particularly for patients being treated for high-cost, complex diseases such as cancer or rheumatoid arthritis (RA)."

Dr. Feinberg’s organization is presenting a series of new clinical studies demonstrating the potential role of PRO research in improving the quality and reduce the costs of treatment provided to patients with complex diseases, at the International Society of Pharmacoeconomic and Outcomes Research (ISPOR) annual meeting.

Here's an overview of some of the key findings they will be presenting:

  • One study used PRO to demonstrate that rheumatologists significantly underestimated the negative impact of RA disease burden and treatment on their patients' sense of well-being. Understanding this disparity in perceptions can help physicians make effective treatment decisions that lessen the burden on patients – and can sometimes also reduce the costs of their care.
  • Another study showed that PRO can be critical to identifying and managing medication access and adherence challenges for high-cost specialty drugs.
  • Of a total of 239 oncology and rheumatology patients who were contacted at the time of their initial prescription to provide patient reported outcomes, 28% were identified as having problems that either restricted access or adherence to the drug.
  • Armed with this information, interventions and support services were provided to address those challenges. With the support of these interventions, a medication possession ration exceeding 95% was achieved – enabling nearly all patients to initiate or continue treatment.
  • A third study  proved the feasibility of collecting PRO at the point of care. In the clinical study involving 3,185 RA patients, PRO data was captured during 90% of physician visits. The participating physicians were then able to utilize the data to inform real-time treatment decisions at the point of care.
Thursday
May072015

Annual Global Oncology Medicine Spending Tops $100 Billion

by Clive Riddle, May 7, 2015 

The IMS Institute for Healthcare Informatics has just released a new report:  Developments in Cancer Treatments, Market Dynamics, Patient Access and Value: Global Oncology Trend Report 2015 which tells us “total global spending on oncology medicines – including therapeutic treatments and supportive care – reached the $100 billion threshold in 2014, even as the share of total medicine spending of oncologics increased only modestly.” 

The report found that “growth in global spending on cancer drugs – measured using ex-manufacturer prices and not reflecting off-invoice discounts, rebates or patient access programs – increased at a compound annual growth rate (CAGR) of 6.5 percent on a constant-dollar basis during the past five years. Oncology spending remains concentrated among the U.S. and five largest European countries, which together account for 66 percent of the total market, while the rising prevalence of cancer and greater patient access to treatments in pharmerging nations continues to grow and now accounts for 13 percent of the market” 

Murray Aitken, IMS Health senior vice president and executive director of the IMS Institute for Healthcare Informatics tells us“the increased prevalence of most cancers, earlier treatment initiation, new medicines and improved outcomes are all contributing to the greater demand for oncology therapeutics around the world. Innovative therapeutic classes, combination therapies and the use of biomarkers will change the landscape over the next several years, holding out the promise of substantial improvements in survival with lower toxicity for cancer patients.” 

Findings shared in the report include: 

  • Growth in the U.S. has risen more slowly at 5.3 percent CAGR, reaching $42.4 billion in 2014, representing 11.3 percent of total drug spending compared to 10.7 percent in 2010.
  • in the EU5 countries oncology now represents 14.7 percent of total drug spending, up from 13.3 percent in 2010.
  • Targeted therapies now account for nearly 50 percent of total spending and have been growing at 14.6 percent CAGR since 2009.
  • Within the U.S., two-thirds of Americans diagnosed with cancer now live at least five years, compared to just over half in 1990.
  • The availability of new oncology medicines varies widely across the major developed countries, with patients in Japan, Spain and South Korea having access in 2014 to fewer than half of the new cancer drugs launched globally in the prior five years.
  • Average therapy treatment costs per month have increased 39 percent in the U.S. over the past ten years in inflation-adjusted terms. Over the same period, patient response rates have improved by 42 percent and treatment duration has increased 45 percent, reflecting improved survival rates.
  • Within the U.S., patient out-of-pocket costs have risen sharply for intravenous cancer drugs, increasing 71 percent from 2012 to 2013, reflecting changes in plan designs and increased outpatient facility costs. 

An interactive version of the full report is available via iTunes, but requires am iPad for viewing. Pdf versions of exhibits can be downloaded here

Friday
Apr242015

Does Patient Satisfaction Matter? 

By Kim Bellard, April 24, 2015 

In a provocative article for The Atlantic, Alexandra Robbins posits that we may have a "problem with satisfied patients."  Ah, only in health care...

Ms. Robbins fears that hospitals may be focusing too much on making patients happier, rather than on making them well.  She cites how hospitals are rushing to provide "extra amenities such as valet parking, live music, custom-order room-service meals, and flat-screen televisions," which may help patients have a better experience but which mean resources not going directly to patient care.

She may have a point.

Ms. Robbins' analysis found that hospitals that do poorly on three or more categories of patient outcome measures actually score above average on patient satisfaction.  In her words: "Many hospitals seem to be highly focused on pixie-dusted sleight of hand because they believe they can trick patients into thinking they got better care."

Ouch.

Ms. Robbins cited a 
2012 study by Fenton, et. alia, that further quantified the patient satisfaction "problem."   According to their research, patients with the highest satisfaction also have higher odds of inpatient admissions, greater prescription drug expenditures, higher overall expenditures, and higher mortality.

Patient satisfaction is clearly in vogue, as evidenced by
CMS unveiling its star ratings on Hospital Compare last week, based on HCAHPS results, and by Medicare's increased focus on value-based payments.  The 2015 HIMSS Leadership Survey found that 87% of respondents listed patient satisfaction as their organization's top priority, higher than even sustaining financial viability (85%).

AHA's official response to the CMS ratings was cautionary: "There's a risk to oversimplifying the complexity of quality care or misinterpreting what is important to a particular patient, especially since patients seek care for many different reasons."

OK, fair enough...so what does AHA propose instead?

Another study on patient satisfaction,
by Vanguard Communications, looked at patient reviews of physicians, and also found some unexpected results: "Ironically, the analysis indicates that generally as a doctor’s level of education and training increases, patient satisfaction actually decreases."

I didn't see that one coming.

Vanguard believes that the ratings reflect more about customer service than clinical quality.  Ron Harmon King, Vanguard's CEO, says:  "Does that mean more highly trained specialists deliver poorer customer service? We can’t say with any certainty, although we found a correlation."

The Physicians Foundation 2014 survey found that 42% of respondents did, indeed, list a customer-service related reason for why they were satisfied with their family physician, way ahead of actual treatment related reasons (26%).  

 
Ms. Robbins is thus not alone in being skeptical about patient satisfaction scores.  She backed up her skepticism with a quote from nurse Amy Bozeman: "The patient is NOT always right. They just don’t have the knowledge and training."  

I hate to break it to either of them, but even with all our health care professionals' knowledge and training, our health system's record on quality is 
pretty dismal.

Look, patient satisfaction is not a perfect measure, nor should it ever be the only measure used, but it has to be an important measure.  I can see patients being initially swayed by amenities or even simple courtesy, neither of which have typically been in abundance in our health system.  But we can't afford to forgo the burgeoning effort to focus on improving patient satisfaction.  At some point we have to trust that patients will see through smiles and nicer waiting rooms, and judge quality based on whether they are actually getting better.

And, in fact,
research from Johns Hopkins suggests that patients may not fall for "pixie dusted sleight-of-hand" tricks after all.  The study concluded that:

"Patients responded positively to pleasing surroundings and comfort, but were able to discriminate their experiences with the hospital environment from those with physicians and nurses...Hospital administrators should not use outdated facilities as an excuse for suboptimal provider satisfaction scores."   

As Abraham Lincoln famously said: "You can fool all of the people some of the time, and some of the people all the time, but you cannot fool all the people all of the time."

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Thursday
Apr162015

Vormetric Report: 48% of Healthcare organizations Had Data Breach or Failed Compliance Audit in Past Year

By Clive Riddle, April 16, 2015

Given the Anthem health plan hack in February, and other healthcare organizations that have fallen victim to breaches as of late, surveys offering threat assessments are certainly of interest. Vormetric just released the twenty-page 2015 Vormetric Insider Threat Report, which includes healthcare industry specific data.

How does Vormetric define Insider Threats? "Insider threats are caused by a wide range of offenders who either maliciously or accidentally do things that put an organization and its data at risk. The insider threat landscape is becoming more difficult to deal with as the range of miscreants moves beyond employees and privileged IT staff. It now includes outsiders who have stolen valid user credentials; business partners, suppliers, and contractors with inappropriate access rights; and third-party service providers with excessive admin privileges. Unless properly controlled, all of these groups have the opportunity to reach inside corporate networks and steal unprotected data."

Vormetric's 2015 Insider Threat Report was conducted online by Harris Poll during fall 2014, with 818 global respondents who work full-time as an IT professional with major influence in decision making for their company’s IT. In the U.S., 408 ITDMs were surveyed among companies with at least $200 million in revenue with 102 from the health care industries, 102 from financial industries, 102 from retail industries and 102 from other industries.

Vormetric reminds us that hacker attraction to healthcare is fueled by black market “healthcare records selling for tens to hundreds of dollars, while U.S. credit card records sell for 50 cents or less.” Alan Kessler, Vormetric tells us "healthcare data has become one of the most desirable commodities for sale on black market sites, yet U.S. healthcare organizations are failing to secure that data. An overreliance on compliance requirements and a cursory nod to data protection point to systemic failures that are putting patient data at risk. What's needed is for healthcare organization to realize that compliance is not enough, and to implement the controls and policies required to put the security of their data first."

Among healthcare organization respondents to their survey, 48% encountered a data breach or failed a compliance audit in the last year. 26% of healthcare respondents reported that their organization had previously experienced a data breach. 54% reported compliance requirements as the top reason for protecting sensitive data, and 68% rated compliance as very or extremely effective at stopping insider threats and data breaches.

63 percent of healthcare IT decision makers report that their organizations are planning to increase spending to offset data threats, which was the highest of any segment or region measured in the report.

When asked about the most important reasons for securing sensitive data, the top three responses from the healthcare sector were compliance (55%), implementing best practices (44%) and reputational protection (41%). In comparison to other business sectors the compliance response was 5 percentage points above other industry averages.

Friday
Apr102015

Accenture Pegs 2015 Private Exchange Enrollment at 6 Million

By Clive Riddle, April 10, 2015

Accenture has released a new report on private exchange enrollment: Private Health Insurance Exchange Enrollment Doubled from 2014 to 2015, which pegs 2015 total private exhange enrollment at 6 million, up from 3 million in 2014.

Accenture forecasts that enrollment in private health insurance exchanges will grow to 12 million in 2016 and 22 million in 2017. They have gone on record projecting "total enrollment in private exchanges to ultimately surpass state and federally funded exchanges, reaching 40 million by 2018."

Here’s more on Accenture’s findings from their report:

  • Accenture concludes that midsize employers, defined as companies with 100 to 2,500 employees, contributed most to the adoption of private health exchanges increase.
  • 76 percent of consumers with employer-sponsored coverage see health insurance as a primary factor for continuing to work at their current employer
  • Accenture points out that this limits some employers’ ability to drop or defund health coverage.
  • Accenture postulates that for such employers, "private exchanges will emerge for some as a compelling model to reduce costs and administrative burden"
  • Accenture notes that private exchange enrollment is expected to accelerate in 2017 due to looming penalties for “Cadillac” Plans.
  • Accenture  also notes that market funding is growing, citing  Aetna’s bswift acquisition of bswift and Mercer’s equity investment in Benefitfocus
  • Accenture further postulates that Accenture expects that "increased compliance requirements .. will drive employers to adopt new models for managing benefits administration."