Dean Health Plan

Objective To evaluate the impact of opioid safety edits on opioid utilization. Design Retrospective review. Setting Senior Care Action Network (SCAN) Health Plan, a Medicare Advantage Prescription Drug Plan. Patients, Participants The opioid safety edits reviewed included edits for the following: initial opioid fill more than 7 days' supply (DS), cumulative opioid doses 90 or greater and 240 or greater morphine milligram equivalent (MME), concurrent opioid and benzodiazepine (COB) use. Members with prescription drug claims meeting these criteria pre- and postedit implementation and those with prescription drug claim rejections resulting from the edits were included in the review. Results 15,232 members experienced claim rejections resulting from the edits. Comparison of utilization pre and postedit implementation revealed the following results (P < 0.001): 41% decrease in the proportion of members with an initial opioid fill for more than 7 DS; 18% decrease in the proportion of members on opioid doses 90 MME or more; 26% decrease in the proportion of members on opioid doses 240 MME or more; 18% decrease in the proportion of members with COB. Conclusion Opioid safety edits are an effective way to combat overuse and misuse. They serve as a means for increasing collaboration between plans, prescribers, pharmacists, and members which improves care coordination, reduces adverse risks, and helps keep members safe.

This paper explores mindfulness as a body/mind tool to expand a person's ability to discover solutions. Like solution-focused therapy, mindfulness simplifies the change process by eliminating the focus on pathology and instead working more directly with solutions. A simplified approach using brief moments of mindfulness can be used to discover solutions in psychotherapy and stress management groups. People in group treatment report as much as a 40% to 50% reduction in symptoms.

Journal Article Medical Services in Social HMOs: A Reply to Harrington et al. Get access Walter Leutz, PhD, Walter Leutz, PhD Associate Research Professor Brandeis University Institute for Health Policy Waltham, MA Search for other works by this author on: Oxford Academic PubMed Google Scholar Merwyn R. Greenlick, PhD, Merwyn R. Greenlick, PhD Director Kaiser Permanente Center for Health Research Portland, OR Search for other works by this author on: Oxford Academic PubMed Google Scholar Jeanne Ripley, MBA, Jeanne Ripley, MBA Director Geriatric Programs Health Partners Minneapolis, MN Search for other works by this author on: Oxford Academic PubMed Google Scholar Sam Ervin, ACSW, Sam Ervin, ACSW President SCAN Health Plan Long Beach, CA Search for other works by this author on: Oxford Academic PubMed Google Scholar Eli Feldman Eli Feldman Executive Vice President Elderplan, Inc.Brooklyn, NY Search for other works by this author on: Oxford Academic PubMed Google Scholar The Gerontologist, Volume 35, Issue 1, February 1995, Pages 6–8, https://doi.org/10.1093/geront/35.1.6 Published: 01 February 1995

The rancor accompanying the repeal of most of the 1988 Medicare Catastrophic Act reflects both the national need to improve health and long-term care benefits for the elderly and the political obstacles to finding new sources of financing for such benefits. Neither the need nor the obstacles will go away, but policymakers are now likely to look for lower-cost, efficient, and privately funded alternatives. The authors have developed and tested one such approach: the Social Health Maintenance Organization (SHMO). Operating since 1985, the SHMO model integrates community-based, long-term care services into the managed, prepaid HMO design. The four test sites are adding long-term care to Medicare at no extra cost to the government and only modest premiums for the 17,000 current members. Although the benefits offer limited protection for long-term nursing home care, they do cover long-term care in community settings, where people tend to prefer to stay. Also, integration of the acute and long-term care systems improves the ability to respond to the medical needs of frail members, who also have high acute-care use. The SHMO's model of front-end, community-oriented, long-term care benefits integrated with Medicare appears to be a practical, affordable, and clinically appropriate way to address the rising concern with the lack of coverage and services for long-term care.