Foldes Consulting Working on the Economics of Tobacco Control.

Foldes Consulting LLC has been retained by Professional Data Analysts, Inc. (PDA), an independent evaluation and statistical consulting firm specializing in the fields of public health and the behavioral and medical sciences, to consult on state-level Return on Investment studies of tobacco control efforts.  Foldes Consulting is advising PDA researchers on conceptualizing and conducting research studies to demonstrate the ROI of population-based tobacco control programs.

Foldes Consulting Developing an Economic Model of Alzheimer’s Disease.

Working under contract with Preparing Minnesota for Alzheimer’s by 2020, Foldes Consulting LLC is creating an economic model of Alzheimer’s Disease and other dementias (AD/OD) for Minnesota.  Due to be completed in June, 2013, the objective of the model is to estimate the cost-saving potential of two interventions that have successfully reduced the cost of caring for persons with AD/OD.  Kirsten Hall Long, Ph.D., a health economist and independent consultant, is collaborating on this project with Dr. Steven Foldes.

The interventions being modeled include caregiver support, as tested by Mary Mittelman (NYU), and the Transitional Care Model developed by Mary Naylor (Penn).  The model will be a population-based Markov model, and will separately estimate the savings potential of implementing these interventions for the state of Minnesota and for Minnesota’s publicly insured eligibles.

Dr. Steven Foldes joins Economics Workgroup of Preparing Minnesota for Alzheimer’s by 2020 (PMA 2020).

The vision for PMA 2020 is to prepare Minnesota for the budgetary, social and personal impacts of Alzheimer’s disease by implementing the recommendations of the Alzheimer’s Disease Working Group (ADWG).  PMA 2020 is led by community leader Robert Karrick (Chair) and Lt. Gov. Yvonne Prettner Solon (Honorary Chair).

To address the mounting Alzheimer’s crisis in Minnesota, the 2009 Minnesota Legislature called on the Minnesota Board on Aging to establish the Alzheimer’s Disease Working Group (ADWG) to study the status of Alzheimer’s disease in Minnesota and make recommendations for needed policy and program changes that will prepare the state for the future.  The ADWG was a multi-perspective, statewide group that worked for 16 months and reported their findings to the MN Legislature in January 2011.  The full report is available at:

Foldes Consulting Joins CIBER for Management Consulting Effort.

Dr. Steven Foldes joined CIBER, Inc., an international IT consulting house, in a review of a large Minnesota health plan’s geo-mapping, disruption reporting and claims repricing operations.  The consultation documented multiple problems and inefficiencies and produced recommendations that would save the health plan more than $500,000 annually in administrative expense and potentially increase the discount it could offer customers by 1-1.5 percentage points.

Chronic care approach to smoking cessation shows positive results.

Anne Joseph MD and colleagues reported results from a randomized control trial of smoking cessation using a “chronic care” approach and demonstrated substantial improvement in both short and long-term quit rates compared to usual care.  The intervention was based on chronic disease management principles of care, including targeting the goal of quitting smoking but incorporating failures, setting interim goals, and continuing care until the desired outcome was achieved.  At 18 month follow-up, the intervention group was approximately 75% more effective at accomplishing long-term abstinence than delivery of a discrete episode of care for smoking cessation.  The intervention lasted 1 year, but quit rates in the intervention group continued to rise during the year without reaching a plateau, suggesting that treatment might be even more effective if extended longer.  On average, the cost of counseling per participant was $718 in the intervention group, compared with $379 in the usual care group.  The mean cost of nicotine replacement therapy per participant in the intervention group was $226 compared with $107 in the usual care group.  The article from the Archives of Internal Medicine is available here:

New study suggests that ACOs might raise health care costs by increasing market concentration.

Health economist James Robinson (UC Berkeley) presents new findings to support concerns over hospital consolidation and market power.  Using individual level data from 61 hospitals for patients treated during 2008 for any of six high-cost inpatient cardiac or orthopedic procedures such as angioplasty and hip replacement, he shows that hospitals in concentrated markets charge significantly higher prices to private payers than do their peers in more competitive markets.  For example, the average hospital in concentrated markets received $32,411 for each commercially insured patient undergoing coronary angioplasty, or one and a half times the $21,626 received in competitive markets.  Similarly large price differentials are observed across markets for the other five procedures, with all differences statistically significant.  Furthermore, these prices are significantly above their direct costs of providing care.  Professor Robinson points out that the vertical integration that ACOs encourage may only exacerbate these trends.  For a summary of the research, see

Important new report from Commonwealth Fund Commission on a High Performance Health System.

The Commonwealth Fund’s prestigious Commission on a High Performance Health System released its third national scorecard on October 18, 2011, tracking the performance of the U.S. health care system since 2006 across 42 indicators.   The scorecard finds that—despite pockets of improvement—the U.S as a whole failed to improve when compared to best performers in this country, and among other nations.  The report also finds significant erosion in access to care and affordability of care, as health care costs rose far faster than family incomes.  At the same time, the scorecard highlights some bright spots for the U.S., with notable gains in quality of care in areas that have been the focus of public reporting or collaborative improvement initiatives.

The report, Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011, measures the U.S. health care system across key indicators of health care quality, access, efficiency, equity, and healthy lives.  The scorecard compares U.S. average performance to rates achieved by the top 10 percent of U.S. states, regions, health plans, hospitals or other providers or top-performing countries.  The authors note that the latest data in the scorecard primarily fall between 2007 and 2009, before enactment of the Affordable Care Act.  They point out that provisions in the new law target areas for improvement where the U.S. falls short, particularly in access to care, affordability of care, and support for more patient-centered, coordinated care.

The full report is available at