Highlight on Oklahoma: Precautions and maintenance of programs vital to protecting health

Oklahoma is currently focused on maintaining the health of its citizens (and their pets) in several different areas. From closing an ice cream plant, to keeping an eye out for bird flu, to maintaining mental health programs, the state has its hands full.

Blue Bell plant closed following listeria scare

In March 2015, a cup of ice cream traced back to a Blue Bell facility in Oklahoma was found to be contaminated with listeriosis. On April 3, Blue Bell announced the suspension of operations at its Broken Arrow plant to allow the company to determine the cause of the contamination. The now-recalled contaminated ice cream cups were shipped to institutions, such as hospitals. Listeria infections are prone to affecting people with weakened immune systems, like hospital patients. The outbreak was first identified when five patients who had been hospitalized in Kansas between December 2013 to January 2015 became infected. Three of those patients died. Blue Bell intends to reopen the plant once the investigation is complete.

Department of Agriculture warns of bird flu cases

According to the Oklahoma Department of Agriculture, Food and Forestry, those who have birds and poultry as pets should keep an eye on their health, as two new strains of avian influenza have been identified. Although the disease has not been identified in Oklahoma yet, cases have popped up in surrounding states in the last month. Humans are not in danger of contracting the disease from eating poultry products. However, those who come in contact with ill or dead poultry or wildlife should take precautions before interacting with domestic birds. Any signs of unusual bird sickness or death should be reported to officials.

Positive news for cancer patients

On a more positive note, a bill involving insurance standards for proton radiation cancer treatment has been passed by both the state House and Senate and is under review by Governor Mary Fallin (R). The bill would prevent insurers from holding this type of treatment to higher effectiveness standards than other radiation treatments. Proton radiation was approved by the FDA as a cancer treatment in 1988. However, some insurance companies still regard it as an experimental therapy. Utilizing a proton beam allows the radiation to be more effectively focused on the cancer cells, hopefully sparing damage to surrounding organs. According to the National Association for Proton Therapy, this treatment is painless and patients may have fewer side effects following proton radiation as opposed to traditional radiation.  This legislation does not contain a mandate requiring provision of coverage, but guides insurers on making coverage decision.

Making the case for mental health care

Oklahoma’s budget for the next fiscal year has been reduced by $611 million from the previous year. State agencies are expecting budget cuts. The director of the Oklahoma Department of Mental Health and Substance Abuse Services, Terri White, hopes hers will not be one of the agencies forced to make do with less. In fact, she has requested an additional $10.2 million over last year’s funding to combat decreases in Medicaid reimbursement and maintain important programs.

White has collected data and statistics showing the effectiveness of the department’s services to support her requests. The Systems of Care program, operating in 72 counties, helps school-aged children up to 18 years old with serious behavioral and emotional problems. These children are now at reduced risks for arrest and out-of-home placements. The mental health courts, drug courts, and family drug court have all worked to reduce arrests and the burden on the court system overall. The family drug court saved the Department of Human Services approximately $5 million over three years by allowing faster reunification of participating families in cases where children were removed due to substance abuse in the home.

The number of people in the state needing mental health or substance abuse treatment is somewhere between 700,000 and 950,000, but Oklahoma is only able to help about 190,000 each year. White maintains that the additional amount requested is absolutely necessary to maintain the current state of the program and avoid cutting services provided to at least 5,000 citizens.

Five decades of U.S. health spending data now available with a click

Anyone with questions about U.S. health spending trends over the last 50 years can look for answers from a new interactive application, the Peterson-Kaiser Family Foundation Health System Tracker.

The Peterson Center on Healthcare and the Kaiser Family Foundation teamed up to create the Health System Tracker, which monitors the U.S. health care system’s performance in the areas of quality and cost. The Health Spending Explorer, which is part of the Tracker, is an application that allows users access to data showing five decades  of U.S. health spending by federal and local governments, private insurers, and individuals. The data also includes 15 areas of spending, including, hospitals, physician and clinic care, and prescription drugs. The Health Spending Explorer allows users to compile data and create charts that can be shared on websites and via email, Twitter, and Facebook.

The application provides a wide variety of statistics and promises the most up-to-date health care spending data, which is drawn from the National Health Expenditure Accounts. A user can access not only current health data, but also historical spending data and compare the two with a built-in tool that can adjust the figures for inflation. All of the information can then be compiled into custom charts for a variety of uses.

For example, if a user wanted to compare U.S. health care spending in 2013 with 1960 from all sources, the following chart could be created:

That same spending data could then be broken down by service type:

The application also provides ready-made charts for reference and includes a video tutorial that outlines the steps to access the health data and create customized charts.

Health spending accelerating faster than GDP growth

The amount of money spent on health is accelerating faster than the gross domestic product (GDP), according to an Altarum Institute spending brief. Spending in all health categories increased, with prescription drugs leading the pack. The brief suggests that low GDP growth is the main explanation for health spending taking a larger share, rather than a dramatic increase in health spending. According to some CMS projections, health expenditures will continue to grow faster than GDP through 2023, and will account for 19.3 percent of GDP by that date. In 2012, health care spending financed by all levels of government accounted for 44 percent, or $1.2 trillion. By 2023, government contributions to health care spending is projected to account for 48 percent, or $2.5 trillion.

The numbers

In 2014, national health spending grew by 5.2 percent, and health spending in February 2015 was 6.6 percent higher than the previous February. February 2015 GDP data was not yet available, but the GDP growth from January 2014 to January 2015 was 4.3 percent. Although the GDP fell in 2009, it is now 6.3 percent above the December 2007 GDP level excluding health care spending; the report identified December 2007 as the beginning of the recession. If health care is included, real GDP in January 2015 was 8.8 percent above the December 2007 level. By contrast, health care spending has increased by 21.8 percent over pre-recession levels.

Categories

Prescription drugs grew the fastest over the last 12 months, at 10.5 percent. Hospital growth was not far behind at 9 percent, which represents a significant amount of growth overall as hospital costs account for one-third of health spending. Prescription drug care growth has been consistently high for the past two years, with a peak of 13.1 percent in December 2014.

Report highlights 2014 quality improvement achievements, 5-year goals

CMS’ 2014 Quality Improvement Organization (QIO) Program report describes its new program structure, highlights its recent statistical achievements, offers examples of its successes, and outlines its five-year goals for the QIO program.

Program structure

According to the report, the new structure of the QIO program follows a functional model with two types of QIOs: (1) Quality Innovation Network-QIOs (QIN-QIOs); and (2) Beneficiary and Family Centered Care-QIOs (BFCC-QIOs). This dual function structure separates the regulatory complaint review process from quality improvement work. For example, 14 regional QIN-QIOs work with providers, community partners, and beneficiaries on initiatives to improve patient safety, reduce harm, engage patients and families, improve clinical care, and reduce health care disparities. Two BFCC-QIOs manage all beneficiary complaints and appeals across the nation.

Achievements

According to CMS, recent achievements from the program include:

  • nearly $1 billion in cost savings from combined QIO programs;
  • recruitment of 1,826 professionals potentially impacting 4.1 million beneficiaries;
  • 53 percent reduction in central line-associated blood infections;
  • 20 percent improvement in controlling blood sugar levels among participants screened;
  • 5,021 nursing homes participating in a national collaborative;
  • 6,250 beneficiaries in 981 nursing homes now restraint-free;
  • 3,374 bed sores prevented or healed in 787 nursing homes; and
  • 44,640 potential adverse drug events prevented.

Examples of success

CMS offered examples of its successes in the areas of better health, better care, lower cost, hospital engagement, using data from the Centers for Disease Control and Prevention (CDC) for prevention, and the Million Hearts® initiative.

  • Better health. CMS highlighted the following better health efforts: (1) using faith-based organizations to promote heart health; (2) maximizing electronic health record system benefits for physicians and patients; (3) the Everyone with Diabetes Counts program going national; and (4) partnering with local colleges to train bilingual diabetes educators.
  • Better care. Highlights of better care initiatives included: (1) collaboration with hospitals to reduce health care-associated infections (HAIs); (2) creating a replicable model for sustainable quality improvement; (3) enabling peer-to-peer learning and sharing for nursing home staff; (4) using new processes to prevent adverse drug events; and (5) tools for improving discharge communications and fewer drug errors.
  • Lower costs. Initiatives to lower costs included: (1) implementation of agreed-upon quality measures; (2) the use of value-based payment and quality reporting models; and (3) helping providers in multiple care settings to navigate quality reporting requirements.
  • Hospital engagement. CMS highlighted the cooperation of the Washington State Hospital Association and Qualis Health Quality Innovation Network, the QIN-QIO for Idaho and Washington, which are jointly tackling common health concerns, including reducing hospital readmissions and HAIs.
  • CMS highlighted a 2014 CDC pilot program with seven QIOs to reduce catheter-associated urinary tract infections.
  • Million Hearts campaign. CMS reported that QIN-QIOs are adding a community level connection to the Million Hearts initiative to prevent one million heart attacks and strokes by 2017.

Five-year goals

The QIN-QIO five-year goals focus on the patient and a commitment to achieving better care, better health, and lower costs. They include:

  • improving cardiac health and care disparities;
  • increasing diabetes awareness and education;
  • improving prevention through meaningful use of health information technology;
  • reducing HAIs;
  • improving nursing home resident care and safety;
  • reducing antipsychotic drug use in long-term care facilities; and
  • using a community approach to fully support coordination of care and the reduction of preventable hospital admissions and readmissions.