Nationalize it

Re: “Reform — Does It Just Mean More Regulation,” October 2008. Milton Friedman said long ago, if health care is a right, it must be nationalized.

It is a right. Ask any ER doctor. So a single-payer system will come.

Thomas Allen Barley, MD
North Vernon, Ind.

Two sides of coin

Re: “It’s Time To Ask More of Utilization Management,” October 2008. I think the article is right on the money. Utilization management and quality improvement should function like two sides of the same coin, but they rarely do.

Lori Stephenson, RN
Director of Quality Improvement
Rocky Mountain Health Plans
Grand Junction, Colo.

More data needed

Re: “Help Members To Avoid a Part D Doughnut Hole Crisis,” October 2008. It would be helpful to know the profit margins, in percentage and actual dollars, for branded and generic drugs. Furthermore, members should know the administrative costs and the hassles with prior authorization.

Subodh Kumar Mehra, MD
St. Louis, Mo.

Issue gets complicated

Re: “Plans Feel the Pressure to Vaccinate More Adults,” August 2008. Once again an issue as straightforward as preventing diseases through vaccines is complicated by the fragmented health care delivery system with complete lack of focus on the patient.

Albert Durant Mims, MD
Lake City, S.C.

Watch out for lawsuits!

In your June 2008 interview with Barbara Starfield, MD, she forgets to mention the detrimental effects of lawsuits on our health care system.

Any system avoiding lawsuits will be more efficient and resource-rich than ones possessing them. Yet beyond the efficiency argument is the fact that the lawsuits assaulting our system create exorbitant malpractice insurance costs.

Sadly, areas of this country are left without health care because these prohibitive costs drive away the providers. This phenomenon is uniquely American, I believe, but alas I do not know for sure.

Eugene Bigelow, MBA, RPh
Clinical Staff Pharmacist
Memorial Health System
Colorado Springs, Colo.

E-mail advantage

Thank you for the article “Kaiser’s EMR Push Pays Off” in the June 2008 issue. This article describes the incredible EMR accomplishment Kaiser has achieved, and more importantly, it presents some impressive benefits of the EMR.

In the article, you stated the 7 percent to 10 percent reduction in office visit utilization by using secure e-mail between patients and their doctors, which is one of the findings in a published study.

I would like to underscore that the reduction in utilization occurred even though 63 percent of doctors were low-level adopters with fewer than 15 e-mail encounters a month. If more doctors encouraged their patients to use secure e-mail, even further reductions in the rates of office visits and telephone calls might occur.

Yi Yvonne Zhou, PhD
Manager, Analytics & Evaluation
Kaiser Permanente
Portland, Ore.

Ask the pharmacist

I am very tired of reading how prices will rise or fall because of a behind-the-counter drug class. Where are the articles about the patient being better served by such a class? How about the best outcome for the dollar and time invested for the patient? How about pharmacoeconomics? How about just plain health care efficiency?

I have been out of pharmacy school for over 30 years, and I can still do a good job at what I studied and trained for — selecting the best drug for the patient. Who better to select the appropriate dose, strength, and mode of action than a pharmacist?

The word art is significant, as it involves information gathering, interpretation, communication, and decision making between the pharmacist and the patient. If only physicians knew how many times their prescriptions are not filled because the patient cannot afford it, the patient does not “feel” bad with high blood pressure or high cholesterol, the patient cannot take specific medications while on the job.

Pharmacists have these discussions daily. We are here, patients have access to us, they trust us, and we have the knowledge. Use us.

I have worked almost every aspect of pharmacy: in a large teaching/research hospital, in chains, in my own store, in a clinic, as consultant to extended care facilities, and now in public health. I have enjoyed all facets of my career. The one thing that is constant is the pharmacist’s interaction with patients. Even after the “high prescription error” articles a few years ago, all surveys show pharmacists to be the most trusted health care provider. Use us.

Get the lawyers out of medicine and see the price of health care go down. If physicians were not risking being sued, they might not feel compelled to treat everything with a drug. Paper after paper shows that about 75 percent of all visits to a physician are for conditions that would resolve on their own, without medication, yet we feel compelled to treat!

J. Sue Arnold, DPh
Captain, Indian Health Service
Director of Pharmacy
Claremore Indian Hospital
Claremore, Okla.

Astronomical costs

I wonder if anyone wants to hazard a guess as to the costs of the last 18 years in the United States for the following:

  • Buildings built and maintained by HMOs and insurance companies
  • Salaries, including executive compensation
  • Paper and computer software/hardware
  • Projects such as ill-fated delivery of computers and handhelds to encourage e-prescribing, and “clinical pathways” fiascoes
  • Gifts, golden parachutes, art work purchased, payments to facilitate mergers
  • Payments demanded by and paid to the California insurance commissioner and other insurance commissioners

The medical director of United Healthcare announced publicly in 2000 that his one company had spent a billion dollars in the prior decade questioning doctors’ decisions, and reversed 1 percent. Back to my original question: one trillion? Several trillion?

George L. River, MD
Pittsburg, Kansas.

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Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.