October Lunch & Learn

Primary care is so fundamental to getting good outcomes and controlling costs.  Primary care physicians and other advanced practitioners have been erroneously referred to as "gatekeepers." In fact, they are navigators, advisors, sages, counselors and more.

So many questions involve primary care:

  • Are my covered members with diabetes under best possible control and on a path to avoid costly and disabling complications? And what about those with high blood pressure, high cholesterol and other chronic conditions?
  • Are my members being appropriately advised about alcohol, tobacco, drug use, nutrition and other modifiable risk factors?
  • Can my members reach their primary care physicians and providers to get timely intervention that can prevent costly emergency room treatments?
  • Do my members get good care during transistions of care such as hospital discharges, emergency room follow-ups and more?
  • Do my members have to jump hurdles to be seen when unexpected illness occurs?
  • Are my providers aware of social determinants of health that come to bear on the outcome of any medical treatment (income, adequate housing, access to healthy food, access to transportation, health literacy, a safe home environment, for example)?

Plan on joining us on Thursday October 25 at 11:30for an engaging Lunch & Learn so you can better understand the value of the primary care you are buying for your members. Formal announcement to follow....

Special April Lunch & Learn

Please mark Thursday April 26th from 11:30 to 1:15 for a special lunch meeting. We will meet at QuikTrip's Corporate headquarters. Melisa Weaver, APRN-CNP, will be up from Oklahoma City to lead a discussion of bariatric surgery for obesity.

Many of us help make policies about bariatrics or know employees who have undergone procedures. But are you really versed in the personal side of weight loss surgery and exactly what happens?

Melisa will take us through the whole process of bariatric surgery, starting from the extensive pre-operative evaluation patients go through. She'll step us through the surgery, recovery and the permanent life changes persons experience after these surgeries.

If you are on our mailing list, you should receive an invitation to register in the next several days. If you are not on our mailing list, go to our contact page and let us know.

A reading trifecta for employers who purchase healthcare

Here are three must-reads for you and your company:

  1.  The CEO's Guide to Restoring the American Dream by Dave Chase. WellOK members can download a free copy of the e-version here.
     
  2.   An American Sickness: How Healthcare Became Big Business and How You Can Take It Back by Elisabeth Rosenthal. 
     
  3. Mistreated by Robert Pearl, MD

These three books are great reads and will change your thinking about American healthcare.

 

Alcohol use in US is increasing and high-risk drinking and alcohol use disorders area driving those increases

A publication in JAMA Psychiatry indicates that 1 in 8 Americans may be at risk related to alcohol consumption. This may be a public health problem much like the current opioid epidemic but with a much longer fuse.

READ THE EDITORIAL

The concept of the out-of-work, down-on-luck alcoholic is not operative today. The vast majority of people with alcohol use disorders or risky drinking have jobs and/or are raising families. They are college students and parents and grandparents and in every walk of life. The one thing they all have in common is either a lack of understanding--or a denial--of the risk.

READ MORE ABOUT "SAFE DRINKING"

One big question should be:  how do I measure how much a "drink" is? 

HOW TO MEASURE YOUR DRINKS

 

 

 

Choosing Wisely now for your iPhone

Consumer Reports and ABIM Foundation have extended their collaboration on the Choosing Wisely Initiative by creating a free app for your smartphone. The app provides both the patient's perspective and the physician's perspective on a wide range of medical tests, procedures and treatments.

You may have Amazon, Yelp, Wikibuy and other apps to help you shop for merchandise. Here's one that can help you make better decisions when buying healthcare.

Look in the Apple App Store for the free app.

How much money are we wasting on blood sugar measurements?

A SEEMINGLY SMALL CHANGE WITH A NATIONAL IMPACT

There is no single culprit in the battle against rising healthcare costs; rather, there are many drivers contributing to the increase. Soaring prices for medical services, new costly prescription drugs and medical technologies, paying for volume over value, unhealthy lifestyles, and a lack of transparency concerning prices and quality are all factors contributing to the spike in premiums.

Patients with diabetes require lifetime care to prevent or minimize potential complications- especially affecting the eyes, kidneys, nerves, and blood vessels. Most Type 1 persons with diabetes require insulin, and it’s essential they monitor blood glucose with frequent “finger stick” testing (self-monitored blood glucose or SMBG) or with a continuous glucose monitor.

For decades however, daily SMBG testing has also been ordered for patients with the more common Type 2 diabetes who do not require insulin. Does SMBG benefit exceed cost for this group? Does SMBG improve glucose control? Does it improve lives? Prior clinical research studies suggested perhaps mild benefit, but questions remained.

In 2013 the Choosing Wisely program recommended against “routine” SMBG for those not requiring insulin. An exciting confirmation of this approach was presented at the American Diabetes Association 77th Annual Meeting (and published in the June 10, 2017 issue of the Journal of the American Medical Association).

     - Kenneth Piper, MD, Consulting Physican Advisor, WellOK

"An Americal Sickness" by Elisabeth Rosenthal is a must-read for businesses

Elisabeth Rosenthal is a healthcare writer (and physician) who has published extensively in the New York Times and Kaiser Health News. She recently published "An American Sickness: How Healthcare Became Big Business." It's available on Amazon and other sites.

It's a great read that anyone using, buying or arranging healthcare should get. 

(And remember, if you do make purchases on Amazon, help support WellOK by going to smile.amazon.com and select "WellOK" as the non-profit you support. It won't cost you a penny extra!)

The Curious Case of Duexis

Duexis represents the genius of the pharmaceutical industry in turning lead into gold. A recent article in January 2017 issue of the JAMA Internal Medicine, a respected publication,  pointed out how you may be spending an unnecessary $2000 each month for every member taking this medication.

It’s a combination pill that combines the ingredients in 3 prescription-strength ibuprofen pills (generic Advil) and about 4 over-the-counter famotidine pills (general Pepcid). Purchased individually, the cost for both would be about $16 per month. An enterprising person can actually purchase the same ingredients in different strengths per pill without a prescription for about the same amount.  (For the technically-minded, Duexis is 800mg ibuprofen and 26.6 mg famotidine. A generic ibuprofen is 200 mg and costs about 2¢; a generic famotidine is 20 mg and costs about 8¢.)

The cash price for Duexis at large Tulsa pharmacies is about $2330.00. No, that is not a misprint. The cash price for the prescription is over 144 times the cost of the ingredients separately. When Duexis was first marketed a few years ago, the average wholesale price was about $160. Now the average wholesale price is over $2000. 

The manufacturer encourages usage of the drug by allowing patients to avoid copayments through coupons and other methods. An employer may be paying thousands of dollars each year because an employee can get a drug for free instead of $16 per month.

Why would a pharmacy benefit manager even permit this drug on a formulary? That’s because the PBM may get a rebate from the manufacturer each time the drug is prescribed. Think about this: if your PBM is covering Duexis, you may be paying over $2000 a month you don’t need to and your PBM may be sharing part of that excessive payment while they are “managing” your pharmacy benefits.

There are other ways pharmaceutical manufacturers may circumvent controls that some PBMs put on this medication. The bottom line is the same: the patient may save a few dollars and you waste thousands.

To be fair, Duexis is a combination drug that is intended to assure that people taking a high dose of ibuprofen gets a medicine at the same time that helps protect the stomach and intestinal lining. The vast majority of people can do quite well taking the medications separately.

So does your PBM have Duexis on the formulary? 

New evidence changes recommendations for aspirin in prevention of heart disease

The recommendations here have changed quite a bit. It's now all about risk.

For those between 50-59 years with a 10% or greater risk for cardiovascular disease, the evidence for taking aspirin is pretty good. For those between 60-69, the evidence is not solid and it's a good time for a chat with the doctor or advanced practitioner. For those under 50 or 70+, there isn't good evidence and again, time for a talk with the doc.

Not sure of your risk? That's a number you should know. It's much more important than LDL alone. Many calculators exist; here's one.

Notes from a primary care quality summit

WellOK attended a primary care quality summit in Oklahoma City today and joined physicians, advanced practitioners and other quality-focused individuals from across the state in helping to answer the question: How do we improve the health of Oklahomans? 

The group believed employers do need a place at this table and welcome the business community in joining the quest for (and the expectation of receiving) highest-quality care. They also wished we would begin an expansion into OKC to engage employers there.

Talk about price of care, not price of insurance!

Yesterday, I was reviewing claims for a manufacturing company. One claim stood out as emblematic of the challenges people have being good healthcare consumers. Here's a classic example of price failure:

An employee had a common blood chemistry test, called Comprehensive Metabolic Profile, done at the outpatient department of a prestigious referral health system. Other specialized tests were done at the same time.  The "list" price for blood chem was $978 and the PPO allowable was $625.

This employee could have had the blood chem test done at a local lab nearby (full price less than $10) and had a copay less than a cup of coffee at Starbucks. Instead, this employee had $125 out-of-pocket.

I wonder if anyone had an honest conversation about price with this employee before lab was drawn?

Why does the national conversation focus on the cost of insurance and not the cost of care itself?

May 26th WellOK meeting in collaboration with CMMI and OCHI

Here is the agenda for the May 26th meeting in conjunction with Centers for Medicare & Medicaid Innovation and Oklahoma Center for Healthcare Improvement.  The Business Track starts at 9:45 AM and concludes at 1:00 PM. WellOK members are also welcome to attend any of the sessions.

The meeting place is the Learning Center at the University of Oklahoma-Tulsa Schusterman campus. The registration site provides a map.

Click here to register. Please contact us if any questions.

Plan to attend our May 26th meeting about value-based insurance design and high value primary care

This year, we are again collaborating with Centers for Medicare and Medicaid  Innovation and the Oklahoma Center for Healthcare Improvement. This regional meeting brings together 63 practices, Medicare's innovation laboratory, health systems, payers and other community leaders around high-value primary care and healthcare transformation. WellOK is running a business track focusing on value-based insurance design and we will also have sessions showcasing innovations from four leading Tulsa providers.

Please contact us at for further information.