Comments on: Is More Health Care Better Health Care? http://www.letstalkhealthcare.org/health-care-costs/is-more-health-care-better-health-care/ Sat, 22 Nov 2008 09:00:27 +0000 http://wordpress.org/?v=2.5.1 By: Frank Wharam http://www.letstalkhealthcare.org/health-care-costs/is-more-health-care-better-health-care/#comment-5406 Frank Wharam Mon, 19 May 2008 16:44:35 +0000 http://www.letstalkhealthcare.org/?p=227#comment-5406 Hi Nancy and Charlie, Great questions. As regards potential effects of provider incentives on interpreting results: we used a rigorous study design that should remove such confounders. In essence, we compared high-deductible plan members to a control group that was equally as likely to experience provider incentives, allowing us to isolate the effect of high-deductible health plan membership on cancer screening. And Charlie is right that the guidelines from the period when this study was conducted recommend either FOBT or colonoscopy as equivalent for low risk populations. Our study was too small to determine whether there was a differential impact on low income members but this is obviously an important policy question. Stay tuned... Hi Nancy and Charlie,
Great questions. As regards potential effects of provider incentives on interpreting results: we used a rigorous study design that should remove such confounders. In essence, we compared high-deductible plan members to a control group that was equally as likely to experience provider incentives, allowing us to isolate the effect of high-deductible health plan membership on cancer screening. And Charlie is right that the guidelines from the period when this study was conducted recommend either FOBT or colonoscopy as equivalent for low risk populations. Our study was too small to determine whether there was a differential impact on low income members but this is obviously an important policy question. Stay tuned…

]]> By: Charlie Baker http://www.letstalkhealthcare.org/health-care-costs/is-more-health-care-better-health-care/#comment-5403 Charlie Baker Mon, 19 May 2008 13:02:51 +0000 http://www.letstalkhealthcare.org/?p=227#comment-5403 Hi Nancy - The answers to your questions - to the extent I can answer them - are as follows. Yes, there are some P4P incentives for physicians for mammography and pap smears. And we do a lot of member outreach on all three of these screenings - mailings, phone calls, etc. - which we find to be more effective than anything else we've tried in driving up use/compliance rates. On FOBT vs. colonoscopy, the view during the time period studied (which was a couple of years ago) was that either test was acceptable. Right now, both are discussed interchangeably on the National Guidelines web site. Scoping/seeing has always been preferred by the "profession," - but I wonder about Judy Norsigian's comments about C-Sections and 0% risk tolerance when I hear that. And I don't believe there is any information attached to the study on income. You might want to ask one of the authors about that. On your final point, as long as the bar's open, we might not have to improve the food(!). Hi Nancy - The answers to your questions - to the extent I can answer them - are as follows. Yes, there are some P4P incentives for physicians for mammography and pap smears. And we do a lot of member outreach on all three of these screenings - mailings, phone calls, etc. - which we find to be more effective than anything else we’ve tried in driving up use/compliance rates. On FOBT vs. colonoscopy, the view during the time period studied (which was a couple of years ago) was that either test was acceptable. Right now, both are discussed interchangeably on the National Guidelines web site. Scoping/seeing has always been preferred by the “profession,” - but I wonder about Judy Norsigian’s comments about C-Sections and 0% risk tolerance when I hear that.

And I don’t believe there is any information attached to the study on income. You might want to ask one of the authors about that.

On your final point, as long as the bar’s open, we might not have to improve the food(!).

]]> By: Nancy T. http://www.letstalkhealthcare.org/health-care-costs/is-more-health-care-better-health-care/#comment-5390 Nancy T. Thu, 15 May 2008 10:28:53 +0000 http://www.letstalkhealthcare.org/?p=227#comment-5390 Thanks for the really interesting post. Does HPHC have financial/pay for performance incentives for breast, cervical and colorectal cancer screenings? If so, do you think this had any effect on the results? In other words, the financial incentives for clinicians might have been part of the reason why use for these services didn't change, even with more member cost-sharing. But in a situation like FOBT vs. colonoscopy, if the clinician was equally happy financially with a patient getting one or the other test, the financial difference for the member made a bigger difference. On that issue, is it really a good thing clinically for members to choose FOBT over colonoscopy? The reading I've done on colorecatal cancer screening don't seem to view the two as equally desirable, at least for people at certain ages. Annual FOBT is better than nothing but is it really as good as colonosccpy? Did the DACP study show any differential impact on use rates for Best Buy members by member income? As you know, the concern many people have about higher copayments and deductibles is that they might discourage inappropriate and appropriate use by people with less income. Don't know if HPHC has member income but if you do, I'd love to know if there were any differences. Finally, maybe the Quality and Cost Council wants to partner with the Boston Convention Center to develop a health care cost containment initiative that is focused on bringing huge meetings and events to the city. Some of the excess inpatient capacity could even be converted to hotel space, although we might have to improve the food.... Nancy Thanks for the really interesting post.

Does HPHC have financial/pay for performance incentives for breast, cervical and colorectal cancer screenings? If so, do you think this had any effect on the results? In other words, the financial incentives for clinicians might have been part of the reason why use for these services didn’t change, even with more member cost-sharing. But in a situation like FOBT vs. colonoscopy, if the clinician was equally happy financially with a patient getting one or the other test, the financial difference for the member made a bigger difference.

On that issue, is it really a good thing clinically for members to choose FOBT over colonoscopy? The reading I’ve done on colorecatal cancer screening don’t seem to view the two as equally desirable, at least for people at certain ages. Annual FOBT is better than nothing but is it really as good as colonosccpy?

Did the DACP study show any differential impact on use rates for Best Buy members by member income? As you know, the concern many people have about higher copayments and deductibles is that they might discourage inappropriate and appropriate use by people with less income. Don’t know if HPHC has member income but if you do, I’d love to know if there were any differences.

Finally, maybe the Quality and Cost Council wants to partner with the Boston Convention Center to develop a health care cost containment initiative that is focused on bringing huge meetings and events to the city. Some of the excess inpatient capacity could even be converted to hotel space, although we might have to improve the food….

Nancy

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