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Contributing Voices
Snezana Mahon, PharmD
Snezana Mahon, PharmD

Medicare plans are furiously working to develop an optimal 2015 bid to submit to the Centers for Medicare & Medicaid Services. The pressure is especially acute this year given the rapidly consolidating and fiercely competitive Part D environment. Missteps in the bid development process have always been costly — affecting member acquisition and retention and overall profitability for the plans. But in the current environment, bid errors paired with a poor star rating will severely reduce payments from CMS and likely put plans out of business.

It’s important to understand the implications of several changes CMS proposed affecting preferred networks and enhanced alternative plans.

Contributing Voices
Steven Peskin, MD

The title of this post might also read "Don't Mess with Mother Nature"

We have seen remarkable improvements in human health as a direct result of the science that has brought us our antibiotic age with significant reductions in infant mortality, deaths due to bacterial pneumonia, and other serious infections that sometimes led to systemic infection and death.

Fast forward to today, when we may obtain with a prescription many of these powerful germ killers for $4 at WalMart and Target and drug and grocery store chains. Some retailers even give away a prescribed course of antibiotics as a loss leader to entice the customer to enter that store.

The liberal (excessive, really) use of antibiotics in the United States and much of the rest of the world is having profound unintended negative consequences.

News & Commentary

Incidence of melanoma among middle-aged people soared in the last 40 years, according to a study in Mayo Clinic Proceedings. The cause isn’t clear, but researchers point to use of tanning salons. Data were collected at the Olmstead (Minn.) Medical Center and the Mayo Clinic.

Medication Management
Thomas Reinke

Getting the right drug to the right patient at the right time can reduce expensive downstream medical services, such as emergency department use. Information needs to be detailed, targeted, and meaningful. New software sifts through medical and pharmacy claims to identify therapy management opportunities. 

MC TV

About $750 billion is wasted in health care each year, says David B. Nash, MD, MBA. “It’s almost hard to get your arms around it.” Performance needs to count. “The punch line is all about in God we trust, all others bring their outcomes data.” 

Watch the full interview with Dr. Nash or read the edited transcript.

Legislation & Regulation
John Carroll

Farzad Mostashari, MD

Slightly less than half of the 114 accountable care organizations (ACOs) in the Medicare Shared Savings Program reported lower spending against their benchmarks. Only 29 of those actually lowered costs enough to qualify for a shared-savings cut. Many questions. Many concerns.

News & Commentary

Which is unfortunate for patients who suffer a heart attack on weekends or off hours. They’re more likely to die than those who get stricken during normal business hours, say researchers. The difference in outcomes “is likely associated with availability of cardiologists” and support staff.

Feature
Peter Boland, PhD
David Gibson, MD

Insured patients are liable for ever-growing out-of-pocket costs that many cannot pay. Each segment of the health care industry will be forced to contend with the unintended consequences of consumer debt, and the resulting dynamic will strain business relations among employees, employers, insurers, and providers.

Peer-Reviewed
Santosh J. Agarwal, BPharm, MS
Gary V. Delhougne, JD, MHA
Levi Citrin, JD
Jill E. Sackman, DVM, PhD

One of the reasons costs rise is because technology keeps getting better. That does not always have be the case, however. MIS is worth adopting, this study indicates, because it has demonstrated both clinical benefits and a reduction in hospital cost per case when used for colectomy, hysterectomy, and thoracic resection. 

News & Commentary

Depression and diabetes have long been associated. A study links diabetes with bulimia, binge eating, and intermittent explosive disorder. A key point: These disorders are often evident long before the appearance of diabetes. Targeting the eating disorder might be the best defense.

Feature
Thomas Reinke

More than 2 million antibiotic-resistant infections occur annually — a huge and chronic problem in health care that’s being addressed in new ways. Insurers and accountable care organizations are starting to work together to help physicians reduce inappropriate prescribing of antibiotics, making them think twice.

Snapshot

There has been a surge in Medicaid rolls thanks to the Affordable Care Act. About 6.3 million more people were deemed eligible as of mid-January. Covering this population presents unique challenges: Almost half have not had insurance for five years or more and 18% say they never had it. 

News & Commentary

Good news: Overall death rates for all childhood and adolescent cancers declined by more than 50% since 1975. Bad news: Survivors are vulnerable to a host of problems as they get older. For instance, some who’ve overcome Hodgkin’s lymphoma have an increased risk of developing lung cancer.

Feature
Thomas Reinke

Tricia Barrett, MHSA

Mental health conditions have not been dealt with during medical treatment. Likewise, people with mental health conditions have not had their medical conditions managed. That’s changing because new ways of providing behavioral health care are being adopted just as the federal rule on parity is taking effect.

Contributing Voices
Steven Peskin, MD
Steven Peskin, MD

Three days of a severe headache that would not respond to the ibuprofen, naproxen, or acetaminophen. "I never get headaches" is what I said multiple times to my wife and to colleagues. The morning of day three, a rash started to appear on my forehead, in the left eyebrow, in the scalp, with swelling around the left eye and swollen lymph nodes at the angle of the jaw on the left. My wife mentioned "shingles". Poor early diagnosis on my part, and, I said "Oh !*#%! that is what I have".  I was starting to feel as if I had been taken out by an NFL linebacker.

Viewpoint
Al Lewis

Al Lewis

When Al Lewis, founder of the Disease Management Purchasing Consortium, went to a specialist, he was bombarded with unneeded options. “Doctors do doctor-type stuff because they’re doctors, and unless you literally take away any payment involved in doing more, they will continue to do what they are trained to do.” 

Tomorrow's Medicine
Thomas Morrow, MD

Thomas Morrow, MD

The key is measuring chemotherapy agents’ efficacy based on aptosis — cell death — as reflected by cells’ changing optical density. A new test produces a report that shows the sensitivity of tumor cells to therapy. The technology may allow individually selected older therapies to become the therapies of the future.

Cover Story
Susan Worley

Randall Krakauer, MD

Too many terminally ill patients receive expensive and aggressive treatment that diminishes quality of life. Medicare weighs whether to go beyond palliative care, while Aetna discovers that a more humane and less costly approach involves allowing curative treatment and loosening admission criteria.

Managed Care Outlook

Improving economic conditions and success fighting heart disease and HIV mean that more people are living longer, better lives. A good thing. However, it also means that dementia rates will explode by 2050. New data from China and Africa bring new concerns.

News & Commentary

It’s a tough audience, too, say researchers, “given that low-income and uninsured patients across the United States generally rate their care much lower.” The study says that 84% of about 4,500 patients surveyed think that PCMHs provide excellent or very good overall quality.