MOOD — Managing Obstacles to Improved Outcomes in Depression: A Collaborative Approach

Depression is a significant — and inadequately addressed — health problem in the United States. Numerous challenges to adequate diagnosis and treatment of depression have been identified, and some of the barriers are pronounced in certain regions of the United States. Identification of these diverse barriers to optimal treatment provides multiple opportunities to achieve better outcomes. This publication focuses on opportunities for collaboration among primary care physicians, mental health specialists, third-party payers, and patients, to recognize strategies for effective management and treatment of depression.

Highlights:

  • Dialogues on Depression Management: Specialist and Primary Care Perspectives
  • Depression Management: Applying Skills in the Clinical Setting
  • Regional Issues in Care: Organized Care and Employee Assistance Programs;
  • Lack of Access in Rural Regions; Unions and Collective Bargaining; and Cultural Diversity and Special Populations

Based on regional symposia conducted at four locations in the United States, this supplement examines opportunities for, and examples of, collaboration — and presents two case studies in context. The authors also present highlights from the regional symposia with an emphasis on common needs of employers and populations in each area.

Clinical Brief: Abatacept for Rheumatoid Arthritis

This Brief summarizes “Abatacept for Rheumatoid Arthritis Refractory to Tumor Necrosis Factor-Alpha Inhibition” (Genovese et al, New Engl J Med 2005), and includes a managed care analysis by Jaan Sidorov, MD.

Depression in the Workplace

Even though depression is common and treatable, it remains a significant problem for employers. This publication outlines and quantifies the effects of untreated depression, outlines the current state of therapy, and describes resources and techniques employers use to help employees with depression.

Highlights:

  • Actual Cost of Depression Is Not Obvious
  • Is Depression Education Needed?
  • Depression Is Prevalent and Pernicious, Costing Employers Billions Each Year
  • Advances in Drug Therapy Have Improved Outcomes
  • Employers Take Lead in Fighting Depression

Hyperphosphatemia

Hyperphosphatemia is present in patients with end-stage renal disease and is increasingly important as a clinical entity. Several studies have shown that calcium acetate is more cost-effective than sevelamer as a phosphate binder. Calcium acetate can be used effectively with doses of elemental calcium that meet the K/DOQI guidelines.

Highlights:

  • The CARE Study and Cardiovascular Calcification
  • Controversies in the Management of Hyperphosphatemia in Patients With End-Stage Renal Disease

Clinical Brief: Safety of Lipid-Lowering Therapies

This Brief summarizes four studies that examine the safety of HMG-CoA reductase inhibitors (statins). It also includes an analysis for MCOs by Steven R. Peskin, MD, MBA.

Highlights:

  • The Report of the National Lipid Association Statin Safety Task Force
  • International Studies on the Comparative Safety of Rosuvastatin

Medicare Part D: Transforming Managed Health Care

With up-to-date information about Medicare Part D regulations and enrollment, as well as expert analysis of postimplementation implications for third-party payers, this publication is an important educational tool for managed care professionals. The content of this supplement is based on the MMAction Webcast Series on the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

Highlights:

  • Medicare Part D: Enrollment, Exceptions, and Appeals
  • The New Landscape for Caring for the Elderly
  • Part B vs. Part D: Navigating Drug Coverage
  • The Competitive Acquisition Program
  • Understanding Medicare Advantage
  • Impact on Long-Term Care
  • Where We Are and Where We’re Going

The Important Role of Guidelines in the Appropriate Management of Disease States and Their Treatment Options

Based on a symposium at the Academy of Managed Care Pharmacy 18th Annual Meeting and Showcase in April 2006, this supplement examines the purpose of guidelines in managing diseases, with a special emphasis on rheumatoid arthritis. Presenters review new and existing (pre-2005) biologic therapies for RA, describe appropriate uses of the new therapies on the basis of published literature, and identify ways to manage formularies in the absence of guidelines for new RA products.

Highlights:

  • The Role of Guidelines in Managing Diseases
  • Improving the Treatment of Rheumatoid Arthritis
  • Panel Discussion: Using Guidelines in Managed Care

Asthma in the Workplace

Because asthma’s effect on the workplace is profound, it is heartening that increasingly, employers are taking necessary steps to address the 20.3 million Americans with the condition. If ever there was a condition that can be effectively managed through employee education and a well designed health benefit, it’s asthma. Pitney Bowes, to take just one example, offered workshops and overhauled its pharmacy program, reducing emergency room visits for asthma attacks by 6 percent and hospital admissions for asthma by 38 percent for its 35,000 employees.

This publication is divided into four parts: The first part describes the effect of untreated asthma on workplace productivity; the second tracks the evolution of therapy and shows how contemporary therapies have been shown to reduce illness and comorbidities; the third is a summary of asthma initiatives by major accrediting bodies (e.g., the National Committee for Quality Assurance); and the last (by no means the least) looks at employer strategies.

Awakening Insomnia Management: A Collaborative Approach to Improved Care

Based on a satellite symposium at SLEEP 2006 — the 20th anniversary meeting of the Associated Professional Sleep Societies, this supplement reviews past and present sleep management practices and identifies and addresses barriers to suitable care. The authors examines the impact of sleep disorders on patients, providers, and employers.

Highlights:

  • The Economic Burden of Chronic Insomnia
  • State-of-the-Art Sleep Management
  • Effects on the Workplace — What Employers Can Do
  • Goals and Strategies for Health Plans
  • Challenges of a 24/7 Global Society
  • Panel Discussion: Insomnia Management Through Collaboration

Seeing Through Transparency: The Managed Care Evolution

The year 2006 marked the fifth consecutive Medical Director Colloquy. This yearís theme “Seeing Through Transparency: The Managed Care Evolution” probed, challenged, and stimulated rich discussion among participants and faculty about how health plans, employer groups, clinicians, and consumers gather, assess, and use data to evaluate, select, and pay for health care services.

Highlights:

  • The Paradox of Plenty: Implications for Performance Measurement and Pay for Performance
  • Making The Right Things Easier: Physicians and Evidence-Based Medicine
  • Obesity Epidemic: What Treatments Work and Whom Do You Treat?
  • The Future of the Health Care Marketplace: The Quest for Value
  • Panel Discussion: Building Models of Collaboration

Targeted Therapy for the Treatment of Macular Degeneration

Neovascular age-related macular degeneration (wet AMD) is the leading cause of blindness among older people in the United States. Until mid-2006, treatments for this disease had been known for their ability to reduce the rate of disease progression. Since then, a new therapeutic option that has been shown to maintain visual acuity has been made available. This publication reviews the history of, and recent advances in, the treatment of wet AMD.

Highlights:

  • Overview of Age-Related Macular Degeneration
  • Treatments for Age-Related Macular Degeneration
  • Panel Discussion: Ranibizumab Therapy in the Managed Care Market
  • Considerations for Managed Care Decision Makers

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.