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SENTINEL EFFECT REDUCES UNNECESSARY SURGERY; STUDY SHOWS 15 TO 37 PERCENT FEWER PROCEDURES PERFORMED

 SANTA MONICA, Calif., July 14 /PRNewswire/ -- Medical practice guidelines are effective, will be used by doctors, have a "sentinel effect" and do prevent unnecessary surgery.
 These were the key findings of a study of more than 250,000 cases which were reviewed using the Value Health Sciences, Inc., Medical Review System (MRS) over a two year period.
 The study, reported at the recent Association for Health Services Research meeting, not only revealed that 9 percent of the surgeries were inappropriate, but a separate study of data from six HMOs showed an additional 15 percent to 37 percent decrease in the number of requests for the procedures reviewed once guidelines were used. Doctors are changing their practice decisions and ordering fewer unnecessary procedures. This is referred to as the "sentinel effect."
 "In this day of health care reform where much attention is focused on how to contain cost and to improve quality in health care, it is important that a system like the Medical Review System can help identify and prevent inappropriate care," said Jacqueline Kosecoff, Value Health Science' president and chief operating officer.
 "This study also demonstrated that physicians will change their practice patterns to be consistent with guidelines. This is one of the first instances that we are aware of in which guidelines were successfully implemented on a national scale. We suspect that this success can be attributed to the strong scientific basis of the guidelines and to our sponsors' commitment to use them," she added.
 The Medical Review System is an interactive clinically-based expert system that uses scientifically validated practice guidelines to prospectively determine the appropriateness of medical care for more than 11 million people. Value Health clients using this system include 8 of the top 10 commercial health insurance companies, Blue Cross and Blue Shield plans, utilization review firms, HMOs, and provider groups.
 Dr. Kosecoff reported that during 1991 and 1992 Value Health Sciences analyzed a data base drawn from 46 clients in 77 sites nationwide. Of the 251,720 cases analyzed, 9 percent were found, after computer screening and physician review, to involve medically inappropriate procedures. The MRS program saved the company's customers more than $118 million during the study period, or an average of $5,200 for each inappropriate procedure.
 "Although it is important to realize the dollar savings, what is more important is the unnecessary surgery and trauma patients have been spared," Dr. Kosecoff said. The procedures studied included cardiovascular, gastrointestinal, orthopedic, gynecological and otolaryngologic.
 Value Health Sciences is a division of Value Health, Inc. (NYSE: VH), a leading provider of specialty benefit programs and health care information services. Value Health's managed care benefit programs are designed to enhance quality and control costs in selected health care sectors which are of particular concern due to their size, rapid cost escalation and potential for over utilization.
 These areas include prescription drugs, mental health and substance abuse, and foot care. Value Health's health care information services are based upon the use of clinical and data analysis to guide health care decision making. Value Health provides services to more than 25 million Americans and its customers include 33 of the nation's 200 largest companies.
 -0- 7/14/93
 /CONTACT: Jacqueline Kosecoff of Value Health Sciences, 310-315-7403; or Judy Hyfield-Starr of Value Health, Inc., 203-678-3472/
 (VH)


CO: Value Health Sciences, Inc.; Value Health, Inc. ST: California IN: HEA SU:

DD -- NE001 -- 1189 07/14/93 07:59 EDT
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Date:Jul 14, 1993
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