Great ideas for cutting costs: six more strategies to manage the rising costs of health care.

• Author: Cauchi, Richard
• Position: HEALTH CARE

Lawmakers are chipping away at the $400 billion a year states spend on health care through a wide range of approaches, including some innovative local and private sector programs. Many appear to be working.

Monitor Prescription Drug Abuse

Insurance fraud drains public and private health insurers of up to $72.5 billion a year, according to the Coalition Against Insurance Fraud.

To combat one aspect of abuse, databases can store information on the specific prescription drugs patients need, how often they require them, and where they pick them up. When this information is monitored and analyzed, it may identify patterns of illegal use and distribution. This, in turn, can deter fraudulent prescription drug insurance claims and impede the black market resale of prescription drugs. Forty-nine states have authorized prescription drug monitoring programs, although seven are not yet operational.

At least 38 states also require Medicaid beneficiaries suspected of misusing controlled substances to "lock-in" or use a single prescriber and pharmacy. An analysis of Oklahoma's lock-in program in 2009 found that doctor shopping, the use of narcotics and emergency room visits by participants decreased. This saved an average of $600 in narcotics reimbursement per person the first year.

Some states also require patients to have a physical exam before controlled drugs can be prescribed, or show a valid ID when picking up prescriptions at a pharmacy. Other state

requirements include better oversight of pain management clinics, use of tamper-resistant prescription paper, faster reporting and interstate sharing of prescription records.

Expand Information Technology

The use of electronic health records is considered a promising way to reduce administrative costs, improve patients' ability to follow treatment regimens and reduce costly medical errors. Software tools and data analytics also can help health care providers make better decisions, identify the best clinical practices, and reduce fraud. Health information technology is especially helpful in rural areas to monitor, diagnose and treat patients remotely.

Since 2010, the federal government has awarded nearly $7 billion through 10 programs designed to help eligible states, professionals, hospitals and critical access hospitals adopt new or upgrade existing health information technology systems.

Technology should lower costs, according to a 2008 Congressional Budget Office study, by helping providers: avoid harmful and allergic drug reactions as well as duplicative or inappropriate tests or procedures; adhere to proven practices; choose the most cost-effective treatments; and compile data on the effectiveness of various treatments.

The benefits that technology can achieve are becoming more evident. Tele-Intensive Care Units, for example, allow physicians to monitor hospitalized patients from remote locations. One such program at the University of Massachusetts Memorial Medical Center helped to "reduce hospital lengths of stay, lower rates of preventable complications, and improve adherence to best practices," according to a study in the Journal of the American Medical Association.

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