The Tough Economy is Impacting Health (and Potentially HEDIS)

A WSJ article of last week provides a glimpse into the many ways our strained economy is adversely impacting the healthcare-seeking behavior of individuals (see article here). It cites a D2Hawkeye analysis of medical service and pharmaceutical utilization (in a study performed before the most recent Wall Street and Main Street turmoil) and shows widespread impact across many healthcare categories. Consumers are cutting back on everything from mammograms to drugs to physician visits.

These findings should be a big stimulus for health plans, population health companies and PBMs to work more creatively on plan designs and communications strategies to support prevention and medication adherence.

Certainly, many individuals are feeling the pinch of health care costs to a greater extent than ever—with higher co-pays, bigger deductibles and for some Medicare members, the “coverage gap,” all contributing to choices people making. The D2 Hawkeye analysis of several Mid-Atlantic health plans looked at preventive and non-acute health services received between March 2007 and March 2008…

It shows pap smears are down 6% and antidepresssant medication fills declined by 19%

…despite the fact that for most of these members (in the study population) the cost-sharing changes year-to-year were minimal. So, the broader economic reality appears to be forcing consumers into making hard choices – trading off health care for other goods and services, whose prices are simultaneously rising.

NCQA is about to release its 2008 State of Healthcare Quality Report (tomorrow, October 2nd) which is its comprehensive summary of how plans across the nation are performing across the full range of HEDIS indicators . The data will reflect the healthcare services received by members in 2007, levels which from the D2Hawkeye study and other industry sources suggest we’ve declined. ….the time is now for innovation that spurs positive member behavior –in areas ranging from diabetes care to flu shots to colon cancer screening—to take center stage as an antidote to all the negatives the economy is now inflicting.

Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. (source)

This posting was written by Margot Walthall, Population Health Market Leader for Silverlink Communications. Margot has previously worked in director level roles in strategy, member communications and product management/marketing for three health plans and also in product marketing for a population health software and services company.

Margot’s work for Silverlink is focused on multi-channel communications solutions that enable campaigns in the areas of health engagement, health risk appraisals, health education in support of gaps in care/HEDIS, adherence programs, virtual coaching and health program satisfaction measurement. Margot has a master’s degree in health administration, as well as an MBA in marketing.

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4 Responses to “The Tough Economy is Impacting Health (and Potentially HEDIS)”

  1. If insurance companies are really interested in patient centric care they will take the lead in creating a health care system with The Medical Home concept in mind.

    As to the other comment on providers charging whatever they want–most insurers pay me 60-65 cents on the dollar for what I charge and Medicare/Medicaid 50 cents or less on the dollar. I’d hardly call that charging whatever I want.

  2. You wrote . This is not my idea of positive member behavior. Positive member behavior is increased exercise and proper diet to reduce diabetes risk, better diet and eating more high fiber foods to decrease risk of colon cancer. I don’t know how the idea of consumer empowerment became “do what your doctor says and get tests.” An economic downturn on health care demand is good for the industry. Right now providers think they can charge whatever they want. That’s a huge part of why health care costs are increasing. Health plans are not the problem; it’s the providers. Maybe this is the kick in the teeth they need to lower health care costs.

  3. You would think the prescription for antidepressant medication would be up considering all the worry about the economy in the news. Concerning the other health care actions, it makes sense that they are down because many procedures have out of pocket expenses.


  1. Headlines for Oct 3-5 | Health Content Advisors - October 5, 2008

    […] » The Tough Economy is Impacting Health (and Potentially HEDIS) « Patient Centric Healthcare […]

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