Is Health Care Prepared For Bioterrorism?

A Discussion Forum About a 21st Century Health Threat

The bioterrorism incidents in the United States in late 2001 were a wake-up call for the health care community. It forced a critical self-evaluation: Are we prepared to deal with similar events in the future? At its 2003 annual Summer Seminar, the Thomas Jefferson University Office of Health Policy and Clinical Outcomes, led by David B. Nash, MD, MBA, assembled a national and regional leadership group to discuss the health care community’s role in a bioterrorism event and its ability to respond effectively. This supplement presents the perspectives of this panel, which identified preparedness gaps, a national research agenda, and the need for better cohesion locally among first responders to a bioterror incident.


  • Improving Response to Terror and Global Emerging Infectious Disease
  • Creating a Health Care Agenda for the Department of Homeland Security
  • Bioterror Emergency Readiness: A Local Responsibility
  • Setting Research Priorities for Disaster Preparedness: The Role of AHRQ
  • Health Care’s Counterterrorism Efforts: What’s Being Done and What Isn’t

P&T Digest: Dry Eye Syndrome

John D. Sheppard, MD, Chief Medical Editor

The understanding of keratoconjunctivitis sicca (KCS), also known as Chronic Dry Eye Disease or Dry Eye Syndrome, has changed dramatically in recent years. Until the late 1990s, KCS was thought to have been due to aqueous insufficiency. Today, KCS is understood to be a multifactorial disease that also involves inflammation of the ocular surface and lacrimal gland, neurotrophic deficiency, and meibomian dysfunction. Delay in treatment may cause disease of the ocular surface. The American Academy of Ophthalmology, in November 2003, released guidelines for treatment that recognizes these contributing factors to the epidemiology of KCS and provides evidence-based guidelines for treatment. This collection of review articles places the etiology of KCS, the AAO recommendations, and the most recent advances in treatment in perspective for practitioners, MCOs, and physicians and pharmacists who serve on pharmacy and therapeutic committees.


  • Dry Eye Moves Beyond Palliative Therapy
  • Dry Eye: Prevalence, Utilization, and Economic Implications
  • Inflammation: A Unifying Theory for the Origin of Dry Eye Syndrome
  • Guidelines for the Treatment of Chronic Dry Eye Disease
  • Medications for Dry Eye Syndrome: A Drug-Therapy Review
  • Considerations in the Pharmacoeconomics of Dry Eye
  • Issues in the Use of Preservative-Free Topicals

Effective Asthma Management: Current Guidelines and Treatment Options

The 2002 update of the National Asthma Education and Prevention Program’s Expert Panel Report 2 presented evidence-based recommendations for long-term management of asthma. These recommendations reaffirm the value of low to medium doses of inhaled corticosteroids as the foundation of modern asthma therapy. This supplement presents comparative clinical data demonstrating the value of inhaled corticosteroids, as well as descriptions of two successful asthma management programs in two large MCOs.


    • 2002 Update From the National Asthma Education and Prevention Program
    • Clinical and Economic Decision Making in Asthma Management
    • Implementing an Asthma Management Program
    • Improving Outcomes With Appropriate Utilization of Asthma Therapies

Health Care Quality Means Business

This supplement is derived from the Wharton Health Care Management Alumni Association Conference in Philadelphia in October 2002. A distinguished faculty addressed the business case for quality health care. The Institute of Medicine’s reports on medical errors and the urgency of improving the safety of care delivery was the common thread running through many of the presentations herein, which include General Motors’ efforts to reduce waste and inappropriate care, a discussion of the ramifications of the current malpractice insurance crisis, a case study on how technology advances are reducing error rates at a large metropolitan hospital, and more.


    • Quality: The Purchaser’s Perspective
    • Providers’ Opportunities for Quality Improvement
    • The Malpractice Insurance and Quality Conundrum
    • Technology: Enabling Consumers to Know Quality
  • Three Directives for Evaluating the Business of Health Care

Movements in Healthcare Legislation: An Interactive Town Hall

At the 15th Annual Managed Healthcare Symposium, some of the most knowledgeable health care policy experts in the United States were invited to lecture on and then debate the potential effects of current and emerging legislative and regulatory issues on health care and managed care. The conference keynote featured a lively debate between James Carville and Sean Hannity, two highly provocative political consultants. Presenters discussed the Bush administration’s new and proposed regulations for Medicare reform; the effects of national health care policy at the local and organizational levels; the role that technological innovation can play in reducing costs; and the complexities of consumer-centric health care models.


    • Two Perspectives on Today’s Political Issues in Health Care (Carville/Hannity)
    • The Administration’s Medicare Policy
    • Medicare Reform: The Effect of Prescription Drug Coverage on MCOs
    • How State Medicaid Is Developing, Piloting, and Implementing Managed Care Purchasing Strategies
    • Healthcare’s Future Consumer-Centric Models The Future of Healthcare in a High-Tech World
    • Flags of Our Fathers

Managed Care Guidelines for Management of Chronic Kidney Disease

Disease management programs aimed at the ESRD population do not address the substantial costs that these patients generate long before their disease progresses to dialysis or transplantation. Because the average hemodialysis patient incurs annual costs exceeding $70,000, MCOs seek effective ways to improve clinical outcomes and prevent these costs by shifting their focus from ESRD to managing chronic kidney disease. This supplement describes the National Kidney Foundation’s staging system for diagnosing patients with CKD, as well as interventions appropriate to each stage. This system provides a way to slow the development of the disease, reduce morbidity and mortality, and improve patients’ quality of life.


    • Managed Care’s New View of Renal Disease
    • Treating Chronic Kidney Disease
    • Managing Chronic Kidney Disease
    • Preparing MCOs to Manage Chronic Kidney Disease
    • Roundtable Discussion: Optimal Management of the CKD Patient

Managed Care Best Practices In the Treatment and Management of Psoriasis

The emergence of biologic response modifiers for the treatment of plaque psoriasis herals a promising era for a patient population that has long been underserved. Patients and physicians have high expectations now that therapies that are curative, not just palliativem are coming to market. MCOs will take notice, too, as the pharmacotherapeutic focus moves from the older products to the new and costlier biologic therapies. This supplement explores the issues inherent in in this transition.


  • Overview of Psoriasis: Current and Emerging Treatment Options
  • The Cost of Psoriasis
  • Managed Care’s Perspective on Treatment of Plaque Psoriasis
  • Roundtable Discussion: Improving the Standard of Care for Patients With Psoriasis

Seeking A Balance: Weighing the Clinical and Economic Factors of Depression and Anxiety Management

This supplement explores the perspectives of health care professionals, insurers, and business leaders on clinical and economic outcomes for patients with depression and anxiety — two common costly chronic problems. The presentations herein discuss how depression and anxiety are treated and managed, how avoidable morbidity and mortality can be reduced, and the inherent conflicts among health plans, employers, practitioners, and quality management.


    • Health Care Benefits in the 21st Century: What Employers Are Facing and How They Are Responding
    • Mental Health Support Needs: The Employer Perspective in Optimizing Clinical and Economic Outcomes
    • MindSET: Tools to Implement a Behavioral Health Initiative in the Workplace
    • Panel Discussion: Does HEDIS Affect Compliance, Length of Therapy, or Outcomes?
    • An Economic Analysis of SSRI Length of Therapy
    • Improved SSRI Tolerability and Increased Length of Therapy

Implementing a Disease Management Program for Chronic Kidney Disease

In the years ahead, DM programs for chronic kidney disease will improve outcomes and save treatment costs through well-timed and coordinated interventions. This supplement derives from a gathering of health care and business experts who convened to discuss how to improve the care of patients with chronic kidney disease. The panel, moderated by David Nash, MD, MBA, reviewed K/DOQI clinical practice guidelines and approaches to managing chronic kidney disease. The authors also evaluate common barriers to implementation of innovative medical management techniques for CKD and ESRD.


    • Managing Chronic Kidney Disease Stages 3 and 4
    • Utilizing the K/DOQI Clinical Practice Guidelines
    • Practical Applications in Chronic Kidney Disease Management
    • Disease Management Opportunities for Chronic Kidney Disease
    • Roundtable Discussion: CKD Management — Meeting the Challenges

Improving Pain Management In a Managed Care Setting

Persistent nonmalignant pain, which affects 50 million Americans, is a major challenge facing American health care. Chronic pain, a primary reason individuals seek medical care, is a significant driver of direct and indirect costs, exceeding $100 billion annually. This supplement identifies opportunities for managed care medical directors to improve clinical and financial outcomes through pain management and presents an innovative quality-improvement initiative.


  • Persistent Nonmalignant Pain: Implications and Opportunities for Managed Care
  • Identifying Suboptimal Management of Persistent Pain From Integrated Claims Data: A Feasibility Study
  • Health Care Costs Associated With Suboptimal Management of Persistent Pain
  • Applying the PAIN Indicators in a Managed Care Setting To Improve Pain Management

P&T Digest: Hypertension

Marvin Moser, MD, Chief Medical Editor

Hypertension, a major driver of health care resource utilization and expenditures, is a serious public health threat — and by extension, a threat to the health of populations for which MCOs bear responsibility. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recognizes several contributing factors to the epidemiology of hypertension and provides evidence-based guidelines for treatment. This collection of review articles by nationally recognized hypertension experts places JNC-7 recommendations in perspective for practitioners, MCOs, and physicians and pharmacists who serve on pharmacy and therapeutic committees.


  • Hypertension: Prevalence and Economic Implications
  • Management of Hypertension in Light of the New National Guidelines
  • Outcomes Trials Underlying the JNC-7 Guidelines
  • Progression of Uncontrolled Hypertension and Implications for Managing Its Sequelae
  • Hypertension: a Review of Therapeutic Options
  • Fixed Low-Dose Combination Therapy: Current Recommendations
  • Measuring Hypertension Control: NCQA and Beyond
  • Compliance – and Improving It – in Hypertension

Transforming Dyslipidemia Management: Assessing Clinical Outcomes and Cost

The basis of this supplement is the 2003 Medical Director Colloquy, a forum for interaction between top medical managers and a nationally renowned faculty of medical and business professionals. Decision makers in managed care have a range of critical concerns relative to dyslipidemia treatment efficacy, cost, and options. This supplement allows readers to examine the dynamic issues that influence the balance of outcomes and costs. The important ideas generated at the 2003 Medical Director Colloquy, captured in this supplement, point readers toward innovative approaches to dyslipidemia.


    • Consumer-Driven Health Care: Transforming Medical Management
    • Staging: A Revolution in Helping People Change
    • Managing Dyslipidemia in Adults With Diabetes
    • Prevention: Providing Lipid Management in a Large Clinical Practice

The Future of Medicare: A Discussion Forum About Medicare Reform and Growth

As the largest single payer for health care, Medicare has strong influence on care delivery and payment. Yet, the program faces critical challenges in such areas as administration, funding, benefit design, and demographics. In a lively discussion forum moderated by Samuel O. Thier, MD, the three previous administrators of the Health Care Financing Administration — Gail R. Wilensky, PhD, Bruce C. Vladeck, PhD, and Nancy-Ann DeParle, JD — offer insights into how Medicare can meet these challenges.


  • A Case for Comprehensive Support for the Elderly
  • Time To Bring Medicare Into the 21st Century
  • If We Keep Medicare, Who Pays the Bills?
  • What Medicare Should Look Like in 2010
  • Roundtable Discussion: Medicare: An Evolution Nearing Revolution?

Assessing Clinical Outcomes and Cost: Transforming Dyslipidemia Management

This is the second of two reports from the 2003 Medical Director Colloquy, which focused on care and management of patients with dyslipidemia. This supplement includes discussions of new technological tools to optimize care delivery, efficient methods of identifying high-risk patients, and recent advances in the diagnostic arena. It also provides a range of perspectives from an expert faculty on underdiagnosis and undertreatment of dyslipidemia. This meeting yielded novel concepts to balance outcomes and costs of dyslipidemia management.


  • New Insights Into the Nature of Coronary Artery Disease: The Inside View
  • Obtaining Optimal Compliance With Drug Therapy
  • Improving Outcomes and Reducing Cost: The Role of Predictive Modeling
  • The Quality of Health Care: An Employer’s Perspective