International professors discuss healthcare concerns

By JULIA LISS, Daily Staff Reporter
Published April 9, 2014

Two speakers gave a joint lecture Wednesday on international health policies at the University’s School of Public Health, drawing around 40 graduate students and faculty.

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Johan Mackenbach, professor of public health at Erasmus University Medical Center in Rotterdam, the Netherlands, spoke of the recent divergence of life expectancy in Europe and possible explanations for such a trend.

Mackenbach said the trends, which show health disparity based on national income gaps, are the result of a variety of cultural factors. Using charts, graphs and other data to help illustrate his point, Mackenbach showed that periods of democracy had historically higher life expectancies, while periods of more chaotic political climates showed dips in the life expectancies.

Mackenbach outlined 11 specific areas of focus for health policies, including tobacco control, alcohol control, child health and road traffic injury. He said countries that have more preventative health policies — contrary to most U.S. delivery models — showed fewer instances of health problems related to each area of concern.

For example, he said countries with stricter tobacco control regulations and preventative measures to discourage smoking had fewer smokers, lower cigarette sales and fewer smoking-related health issues in the population.

Mackenbach discussed possible reasons for the existing disparities. He found that many countries which could benefit from improved healthcare models often possess the means to do so, but are stymied by the political, social and cultural climate of the country.

John Frank, director of the Scottish Collaboration for Public Health Research & Policy and chair of Public Health Research & Policy at the University of Edinburgh, Scotland, delivered the second address, titled “Influencing Child Health Policies with Scientific Evidence: Lessons from 5 Years in Scotland.”

His lecture aimed to demonstrate the importance of early access to education on an individual’s health and future success. Frank said early education implementation is the single most important indicator for a child’s future.

“You can make people’s chances in life much more equal in only one really cost effective way, and that is giving universal preschool high quality education, half day a week from age two, age one in high risk families,” Frank said.

Frank proposed a plan to combat societal challenges through education, while addressing some of the concerns of implementing potential reforms.

Public Health Prof. George Kaplan acted as the moderator and he introduced both Mackenbach and Frank’s speeches and led a question and answer session after each speaker. The Institute for Healthcare Policy and Innovation, the University’s Robert Johnson Foundation Scholar’s in Health Policy Program and the Center for Social Epidemiology of Population Health sponsored the event.

http://www.michigandaily.com/news/scottish-prof-talks-healthcare-changes-challenges

Managed Medicare Advantage Plans Demonstrate Better Outcomes for Patients

By Analyzing Insurance Claims From 3 Million U.S. Medicare Patients, The Boston Consulting Group Finds That Managed Private Plans Outperform Traditional Fee-for-Service Medicine on Health Care Quality and Value

BOSTON, MA--(Marketwired - May 14, 2013) - As health systems around the world experiment with alternative models for care delivery and reimbursement to improve health care quality and lower cost, they can learn a lot from the care-delivery models used by private payers in U.S. Medicare Advantage plans, according to a new study by The Boston Consulting Group (BCG).

After analyzing claims data for 3 million Medicare patients, BCG found that on three internationally accepted dimensions of health care quality -- single-year mortality, recovery from acute episodes of care requiring hospitalization, and the sustainability of health over time -- patients enrolled in Medicare Advantage plans offered by private insurers had considerably better outcomes than those participating in Medicare on a traditional fee-for-service basis. The improved quality is delivered on top of the well-understood point that these models already deliver lower costs.

"Our findings demonstrate that the more managed plans do not compromise quality. Just the opposite: they deliver higher-quality care at a lower cost than fee-for-service medicine and thus do a better job of improving health care value," said Jon Kaplan, a BCG partner and lead author of the study. "Payers, providers, and policymakers have a lot to gain by more broadly aligning incentives and delivering strong care management, similar to that utilized by the Medicare Advantage plans."

The findings are detailed in a new report titled Alternative Payer Models Show Improved Health-Care Value, released today on www.bcgperspectives.com.

The majority of the U.S. Medicare-eligible population receive care from doctors and other providers on a traditional fee-for-service basis, with the costs of the services reimbursed directly by Medicare. About one-quarter are enrolled in Medicare Advantage health plans provided by private insurers.

What distinguishes Medicare Advantage plans from traditional fee-for-service plans is the degree to which they use mechanisms designed to encourage the delivery of cost-effective quality care. Three critical mechanisms are financial incentives that are aligned with clinical best practices, a selective network of providers, and more active care management that emphasizes prevention to minimize expensive acute care.

Of the 3 million patients for which BCG analyzed data, approximately 1.3 million used providers on a traditional fee-for-service basis. The remainder were enrolled in one of three types of private Medicare Advantage plans: a preferred provider organization (PPO), a health maintenance organization (HMO), or an HMO with global capitation.

Among the study's specific findings:

   -- Single-year mortality rates fell from 6.8 percent in the traditional fee-for-service sample to 1.8 percent in the three progressively managed delivery models. The lowest rates and the greatest performance were seen in the HMO plans with global capitation. Patients in the three managed models achieved these lower levels of single-year mortality quickly, within the first year of enrollment. 
 
   -- Patients in the Medicare Advantage plans had shorter average stays in the hospital. Compared to the fee-for-service sample, the capitated HMO sample had stays that were, on average about 19 percent shorter. 
 
   -- Patients in the managed plans were more likely to receive preventive care and less likely to suffer from disease-specific complications. For example, diabetic patients in the fee-for-service sample had an average of 11.5 amputations per 1,000 patients; those in HMO plans with global capitation had only 0.3. 

"We've found that U.S. private insurers have created an operating model that can deliver better care at a lower cost and have a major role to play in the ongoing national efforts to improve health care quality," said Stefan Larsson, a BCG senior partner and coauthor of the report. "Quite simply, we've found that the more aligned the care, the better the quality delivered."