- On Nov. 2007, the Senate passed H.R.3963; Support
for Injured Servicemembers Act. This legislation expands family and medical
leave in support of servicemembers with combat-related injuries.
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Military Health Care News
- TRICARE Management Activity published a news release
advising its beneficiaries of a new provision in the John Warner National Defense
Authorization Act for fiscal year 2007 which prohibits employers from offering their
employees financial or other incentives to use TRICARE rather than the company’s
Group Health Plan (GHP). This provision, effective Jan. 1, 2007, means that
employers will no longer be able to use TRICARE supplements as an employer-sponsored
medical option in an effort shift their health care costs to TRICARE by offering
financial incentives for employees to use TRICARE rather than the employer’s GHP.
The employer can still offer “cafeteria plans”
to their TRICARE eligible beneficiaries as long as the plans are offered to all
of their employees, including those that are not eligible for TRICARE. The
legislation does not have an impact on “TRICARE Supplement” plans that are not offered
by the employer but are sold by beneficiary associations or commercial insurers.
- The Minnesota Medical Association House of Delegates
recently adopted a resolution to increase its membership’s awareness of TRICARE.
The Minnesota initiative is just one of many from governors in TRICARE’s western
region to ensure beneficiaries have unprecedented access to care.
For two years, TriWest Healthcare Alliance,
the managed care provider for the TRICARE Western Region, and TRICARE program leaders
have spearheaded an innovative program to collaborate with governors in the TRICARE
western region to increase the network of providers delivering care to beneficiaries—especially
for those beneficiaries who may not live near military facilities, and for those
who live in communities where limited military presence means that TRICARE may not
be commonly accepted. The net result is an increase from approximately 80,000
providers to over 125,000.
Governors in the 21-state western region contacted
the medical associations in their states to applaud those providers already participating
in TRICARE and to encourage others to consider contracting with TriWest to deliver
care to military personnel and families in their states.
The outreach focused on ensuring a quality
network of providers at a time when Congress continues to enhance TRICARE benefits
for Guard and Reserve members and their families.
Western region outreach efforts took shape
in 2006 when Deputy Director of the TRICARE Management Activity Maj. Gen. Elder
Granger, TRICARE Regional Office-West Director Rear Adm. Nancy Lescavage, and TriWest
Healthcare Alliance President and CEO David McIntyre met with the Western Governors
Association to encourage its members to assist in communicating expanded TRICARE
benefits to their Guard constituents.
- The Departments of Defense (DoD) and Veterans Affairs
(VA) announced that VA medical providers can now access DoD theater clinical data
using the Bidirectional Health Information Exchange (BHIE) interface. This information
includes inpatient notes, outpatient encounters, and ancillary information such
as pharmacy orders, laboratory results, allergies, and radiology reports for patients
presenting to VA for care or evaluation. This new capability, achieved on
Oct. 6, 2007, improves the ability to share electronic health information of service
members and veterans between the two departments.
First implemented in 2004, BHIE provides a
real-time, bidirectional interface between the Dod electronic record system, called
AHLTA, and the VA’s electronic health record (EHR), called VistA. It allows providers
in both agencies to access and view patient demographic data, outpatient pharmacy
data, allergy data, laboratory results, and radiology reports on shared patients,
regardless of location. Discharge summaries are also available from 13 of DoD’s
largest inpatient sites and all VA’s inpatient locations. http://www.tricare.mil/pressroom/news.aspx?fid=334
- On Oct. 29, 2007, CACI International
Inc. announced it won a four-year $64 million task order to
support the Military Health System’s Information Assurance
Program by providing IT security to healthcare programs in the northern and southern
regions of its agency.
CACI will provide information assurance to the Technology
Management, Integration and Standards (TMI&S) Directorate of the Department
of Defense TRICARE Management Activity.
The main objective of the TMI&S Directorate is to certify
that MHS information systems, as well as TRICARE contractor systems that access
DoD systems, meet DoD standards for IT security.
CACI's role will include helping to provide security management,
technical services and support for DoD certification and accreditation of MHS information
systems. CACI's services will also help the TMI&S Directorate manage and secure
a broad array of medical information to more efficiently serve the needs of the
military community.
- Humana Military Healthcare Services (HMHS) recently
received the Vision Award from the Customer Contact Center Network (C3N) during
the second annual Boomerang Awards. The award, for overall contact center excellence
in the large center (over 101 call center representatives), was given to the most
respected contact center in the region. The Boomerang Awards is an annual competition
recognizing the achievements and contributions of outstanding call centers and call
center professionals in the greater Louisville area.
The Vision Award category recognizes companies that have
achieved outstanding results, innovatively improve processes, are leaders in supporting
and leading change, and exceed goals on a consistent basis. The winner of this category
is considered a role model for other centers; HMHS was cited fore making decisions
that are right for the company and their customers, building relationships with
its employees by inspiring trust, and supporting creativity. The Boomerang Awards
is the only region-wide competition for professionals in the call center and customer
service industry. http://home.businesswire.com/portal/site/google/index.jsp?ndmViewId=news_view&newsId=20071101005717&newsLang=en
- On Oct. 26, 2007, TRICARE Management Activity announced
that nine medications have been designated non-formulary (or third tier) on the
TRICARE Uniform Formulary. The change to six of the medications will be effective
Dec. 19, 2007, and three will be effective Jan. 16, 2008. Medications on the Uniform
Formulary third tier (non-formulary) require a $22 co-payment in the retail and
mail-order pharmacy programs and are not available at military treatment facility
(MTF) pharmacies unless medical necessity has been established and the prescription
is written by an MTF provider. To view the chart of affected medications, please
visit
UF Formulary Changes.
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Veterans Health Care News
- On Oct. 30, 2007, President Bush nominated Lt. Gen.
James B. Peake, U.S. Army (retired), to be the next Secretary of Veterans Affairs.
Dr. Peake currently serves as Chief Medical Director and Chief Operating Officer
of QTC Management, Inc. Prior to this, he served as Executive Vice President and
Chief Operating Officer at Project Hope. Earlier in his career, he served as Surgeon
General and Commander of the United States Army Medical Command. Dr. Peake received
his bachelor's degree from the United States Military Academy and his medical degree
from Cornell University.
- The Department of Veterans Affairs (VA) and the Department
of Defense (DoD) signed an agreement on Oct. 31, 2007, to provide “federal recovery
coordinators” to help ensure medical services and other benefits are provided to
seriously wounded, injured and ill active-duty service members and veterans.
The agreement puts into place one of the top recommendations
of the President’s Commission on Care for America’s Returning Wounded Warriors,
co-chaired by former Sen. Robert Dole and former Health and Human Services Secretary
Donna Shalala.
The agreement initially establishes that the first federal
recovery coordinators will be provided by VA in coordination with DoD and will be
located at top military treatment facilities throughout the nation. They will
coordinate services between VA and DoD and, if necessary, private-sector facilities,
while serving as the ultimate resource for families with questions or concerns about
VA, DoD or other federal benefits.
The first
10 federal recovery coordinators are scheduled to be hired by Dec. 1. Plans
call for the new employees to be trained and in place at four of the military’s
major health care facilities during January 2008.
The coordinators will ensure that appropriate oversight
and coordination is provided for care of active-duty service members and veterans
with major amputations, severe traumatic brain injury, spinal cord injury, severe
sight or hearing impairments and severe multiple injuries. In addition, the
coordinators will work closely with the clinicians and case management teams to
develop and execute individual federal recovery plans for the wounded service members.
Those plans will specify the services needed across the continuum of care,
from recovery through rehabilitation to reintegration to civilian life. The coordinators
will also work closely with family members to take care of services and needs.
The first 10 coordinators will work at military health care
facilities and at any other locations where patients are later assigned. They
will be located at Walter Reed Army Medical Center in Washington, D.C.; the
Naval Medical Center in Bethesda, Md.; Brooke Army Medical Center at Fort Sam Houston,
Texas; and Balboa Park Naval Medical Center in San Diego. Additional
recovery coordinators will be added in the future as needs are determined.
http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1407
- On Oct. 29, 2007, the White House announced that Francis
S. Collins is one of the recipients of the Presidential Medal of Freedom, the nation's
highest civil award. Dr. Collins, a physician-geneticist noted for his landmark
discoveries of disease genes and his visionary leadership of the Human Genome Project
(HGP), is director of the National Human Genome Research Institute (NHGRI).
His work has revolutionized genetic research. Under his leadership, the Human Genome
Project mapped and sequenced the full human genome and greatly expanded our understanding
of human DNA.
Established 1963, the Presidential Medal of Freedom may
be awarded by the President "to any person who has made an especially meritorious
contribution to the security or national interests of the United States, or world
peace, or cultural or other significant public or private endeavors."
- Younger depressed veterans are at greater risk for suicide
than older ones, and unexpectedly, post-traumatic stress disorder exerts a somewhat
protective effect, researchers report in the American Journal of Public Health.
The study examined outcomes in over 800,000 veterans diagnosed
with depression between 1999 and 2004. Younger veterans were found to be at higher
risk for suicide, especially those with diagnoses of substance abuse. Patients with
PTSD diagnoses were, to the authors' surprise, less likely to commit suicide — an
effect they speculate may have to do with the patients' receiving more mental health
services than those without PTSD. (The protective effect, however, was not as strong
among younger veterans.)
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Health Care News
- The Department of Health and Human Services (HHS) announced
a five-year demonstration project that will encourage small to medium-sized physician
practices to adopt electronic health records (EHRs). This demonstration is
designed to show that streamlining health care management with electronic health
records will reduce medical errors and improve quality of care for an estimated
3.6 million Americans. Conducted by the Centers for Medicare and Medicaid
Services (CMS), it would be open to participation by up to 1,200 physician practices,
beginning in the spring. Over a five-year period, the program will provide
financial incentives to physician groups using certified EHRs to meet certain clinical
quality measures. A bonus will be provided each year based on a physician
group’s score on a standardized survey that assesses the specific EHR functions
a group employs to support the delivery of care.
Under the CMS demonstration, all participating practices
will be required to use a certified EHR system to perform specific functions that
can positively affect patient care processes, such as clinical documentation and
ordering prescriptions. The system, which must be in place by the end of the
second year, must also be approved by a certification body officially recognized
by HHS. The core incentive payment to practices will be based on performance on
the quality measures, with an enhanced bonus based on the how well integrated the
EHR is in helping manage patient care.
- Used in conjunction with e-prescribing, EHRs can help
reduce adverse drug events, medical errors, and redundant tests and procedures by
ensuring doctors have access to all their patients’ relevant health history at the
place and time care is delivered;
- EHRs can make it easier for physicians to identify various
serious illnesses and prescribe relevant medication or treatment. EHRs also
can ensure the use of preventive services such as health screenings, which can help
reduce health care costs;
- EHRs yield an organized patient treatment history that
makes it easier to find vital health information and prescribe treatment;
- EHRs can help to improve communication between patients
and providers, giving patients better access to timely information; and
- EHRs can reduce office wait times by improving office
efficiency.
The Certification Commission for Healthcare Information
Technology (CCHIT) is currently the only certification body recognized by the Secretary
of HHS. More information about certification is available on the HHS and CCHIT
Web sites at www.hhs.gov/healthit/certification/background/ and www.cchit.org.
- The Department of Health and Human Services (HHS) Secretary
Mike Leavitt signed a Memorandum of Understanding (MOU) with Canadian Minister of
Health Tony Clement to improve the health status of indigenous communities through
enhanced international collaborations, identification and reinforcement of best
practices, and innovative approaches to learning opportunities.
The MOU, which continues the work of a similar five-year
MOU signed in 2002, will focus on improving health care delivery and access to health
services for American Indian and Alaska Native people of the United States, and
the First Nation and Inuit of Canada.
HHS' Indian Health Service (IHS) will administer the activities
under the MOU for the United States. The IHS is the principal federal health care
provider and health advocate for American Indian and Alaska Native people. It works
with tribal and urban programs to provide health services to approximately 1.9 million
American Indian and Alaska Native people who belong to 562 federally recognized
tribes in 35 states.
The First Nations and Inuit Health Branch is the IHS counterpart
in Canada. It works with more than 600 First Nation and Inuit communities, other
Health Canada branches, and other Canadian government departments to provide health
programs and services to address health disparities. http://www.hhs.gov/news/press/2007pres/11/pr20071101b.html
Studies have found that people with limited health literacy
are 12 to 18 times more likely to be unable to identify their own medications and
distinguish them from one another than people who are more health literate. They
also have difficulty understanding simple instructions, such as taking a medication
every 6 hours, or how their medications work. People with limited health literacy
also are less likely to understand potential side effects and more likely to misinterpret
drug warning labels.
The tools resulted from a study that was co-funded by AHRQ
and the Robert Wood Johnson Foundation and were developed under contract by Emory
University.
The pharmacy assessment tool can help raise pharmacy staff
awareness of health literacy issues, detect barriers that may prevent individuals
with limited literacy skills from using and understanding health information provided
by a pharmacy, and may help identify opportunities for improving services. This
tool includes a pharmacy assessment tour to be completed by trained, objective auditors;
a survey to be completed by pharmacy staff; and a guide for focus groups with pharmacy
patients. The three parts are complementary and are designed to form a comprehensive
assessment.
The training program for pharmacy staff includes the use
of explanatory slides and small group breakout discussions. Participants will role
play using handouts before concluding with a question-and-answer session.
More than a third of adult Americans have levels of health
literacy that are below what is required to understand typical medication information,
according to the National Assessment of Adult Literacy. This problem is more acute
for certain groups, including the elderly, minorities, immigrants, and the poor.
AHRQ's 2006 National Healthcare Disparities Report found that these same groups tend to have poorer health care,
suggesting that limited health literacy may be at least partially responsible for
the disparities.
- The Centers for Disease Control and Prevention (CDC)
released the results of two studies which report that adults with diabetes feel
they are doing better at monitoring their blood sugar, and fewer say they’ve developed
cardiovascular disease.
Among people aged 35 years and older with diagnosed diabetes,
the prevalence of cardiovascular disease decreased by over 11 percent over an eight
year period, according to, "Trends in Prevalence of Self–Reported Cardiovascular
Disease Among Adults with Diabetes Aged 35 Years and Older, United States, 1997
– 2005," published in CDC’s Morbidity and Mortality Weekly Report (MMWR).
The report’s authors note the decrease may be due in part to declining rates
of cardiovascular disease risk factors such as smoking, high cholesterol and high
blood pressure, and to increased use of preventive treatments such as daily aspirin.
Self–reported cardiovascular disease among black adults
with diabetes decreased by more than 25 percent between 1997 and 2005. Blacks
tend to have higher diabetes rates than whites and Hispanics, the other racial/ethnic
groups included in the report.
The report, which analyzed self-reported data from the National
Health Interview Survey (NHIS), also notes a 14 percent decrease in self–reported
cardiovascular disease among adults aged 35–64 years with diabetes, the age range
in which the majority of all new diagnosed cases of diabetes among adults occur.
During 1997 to 2005, prevalence of self–reported cardiovascular disease in
this age group decreased from 31.1 percent in 1997 to 26.7 percent in 2005.
Cardiovascular disease is not only the leading cause of
death for Americans, it is also the greatest killer of adults with diabetes. About
65 percent of deaths in people with diabetes are caused by heart disease and stroke.
Adults with diabetes have heart disease death rates about two to four times higher
than adults without diabetes.
A second MMWR report, "Self-Monitoring of Blood Glucose
Among Adults with Diabetes – United States, 1997 – 2006," found significant
increases in daily monitoring of blood glucose levels among adults with diabetes.
Using data from the Behavioral Risk Factor Surveillance System (BRFSS), researchers
found that adults with diabetes who checked their blood glucose levels at least
once a day increased by more than 22 percent between 1997 and 2006.
In 2006, over 63 percent of respondents checked their blood
glucose at least once daily. This surpassed the national health objective
of 61 percent, as outlined in Healthy People 2010, a government framework for achieving
specific health objectives by the year 2010.
- KaiserNetwork.org reported that the IMS Health
annual forecast predicts that sales growth for prescription drugs in 2008 is expected
to increase at the lowest rate in decades. The report projects that U.S. sales
of brand-name and generic prescription drugs in 2008 will experience growth rates
between four and five percent, compared with rates between five and six percent
this year.
The estimate puts U.S. sales at as much as $305 billion.
Worldwide sales in 2008 are expected to increase to as much as $745 billion, which
also is a deceleration from 2007. In addition, according to the report, the U.S.
will see its worldwide market share for drugs decrease to one-third, compared with
half of global market share two years ago.
IMS said the slowing sales growth in part is caused by increased
FDA regulation and scrutiny of new drugs seeking approval. IMS predicts slower approvals
and more warning labels in the future. Another factor is brand-name drugs losing
their hold on the market as patents expire and generic versions are approved. IMS
estimates that generic drugs will fill two-thirds of U.S. prescriptions in 2008,
compared with half in 2003.
- The National Center for Research Resources (NCRR), a
part of the National Institutes of Health (NIH), announced today it has provided
nearly $33 million to fund three new Institutional Development Awards (IDeA). The
awards support multidisciplinary centers — each concentrating on one general area
of research — that strengthen institutional biomedical research capability and enhance
research infrastructure. The IDeA program is designed to improve the competitiveness
of investigators in states that historically have not received significant levels
of competitive NIH research funding.
The new centers are being established at the University
of Oklahoma Health Sciences Center to study diabetes (especially in the Native American
populations); Rhode Island Hospital to study cartilage, joint health, and repair
mechanisms; and University of Kansas Medical Center to study molecular regulation
of cell development and differentiation.
Through the IDeA program, NCRR supports institutions and
communities in 23 states and Puerto Rico with grants that fund multiple areas of
biomedical research and reach out to unique populations. Each grant fulfills five
goals:
- To build and strengthen the research capabilities at
participating institutions by hiring staff and purchasing research equipment;
- To support faculty, postdoctoral fellows, and graduate
students;
- To provide research opportunities for undergraduate
students;
- To develop outreach activities; and
- To enhance the science and technology knowledge of the
state's workforce.
Each award includes a principal investigator with established
credentials relevant to the center's research theme; three to five individual research
projects that share that theme and are supervised by a single junior investigator;
and a development and mentoring plan that will prepare these investigators to secure
competitive federal research funding.
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- The total number of Guard and Reserve currently on active
duty has increased by 927 from the last report to 93,898. The totals for
each service are Army National Guard and Army Reserve, 73,034; Navy Reserve, 5,895;
Air National Guard and Air Force Reserve, 7,033; Marine Corps Reserve, 7,589; and
the Coast Guard Reserve, 347.
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