Arnold RJ, Massanari M, Lee TA
… +1 more, Brooks E
Manag Care
· 2018 Jul · PMID 29989900
UNLABELLED: Asthma is a common chronic respiratory disease affecting nearly 8% of the U.S. POPULATION: It results in substantially higher direct and indirect costs as well as an increased mortality risk and poorer qualit...UNLABELLED: Asthma is a common chronic respiratory disease affecting nearly 8% of the U.S. POPULATION: It results in substantially higher direct and indirect costs as well as an increased mortality risk and poorer quality of life, particularly among patients with difficult-to-control asthma. While several physiologic tests, including spirometry, are typically used to diagnose and characterize asthma, they do not provide the sensitivity and specificity required to accurately reflect the underlying heterogeneous inflammatory pathways. Fractional exhaled nitric oxide (FeNO) is a validated, noninvasive biomarker for T2-driven (i.e., allergic) airway inflammation that correlates with sputum eosinophils at or greater than 3% across various asthma phenotypes. Its use as a biomarker in asthma is well supported by numerous peer-reviewed articles and guidelines. There is also evidence that its use in clinical settings for patients with uncontrolled asthma is cost effective, given its ability to improve the accurate diagnosis of asthma, monitor treatment response, optimize inhaled corticosteroid dosing, and identify patient nonadherence. It may also have a role in identifying patients who are possible candidates for treatment with biologics.
Now that Geisinger is confident in the payment process for providers, it will continue to innovate new ways to improve the member experience. The goal is to be not just one of the top companies for members and not just o...Now that Geisinger is confident in the payment process for providers, it will continue to innovate new ways to improve the member experience. The goal is to be not just one of the top companies for members and not just one of the top health care organizations, but one of top organizations among all the companies in the United States.
Pyenson B, Dieguez G, Simon K
… +1 more, Bochner A
Manag Care
· 2018 Jul · PMID 29989898
Despite standardization, advocates for various industries and certain patient needs continue to propose changes in coverage rules. Much of the advocacy is occurring at the state level with a focus on pharmaceutical cover...Despite standardization, advocates for various industries and certain patient needs continue to propose changes in coverage rules. Much of the advocacy is occurring at the state level with a focus on pharmaceutical coverage, such as equalizing cost sharing between oral and infused oncology drugs or setting limits on cost sharing for prescriptions.
Price transparency, payment reform, and consumerism are needed to bring market forces to health care. Too many managed care organizations are comfortable with the status quo.Price transparency, payment reform, and consumerism are needed to bring market forces to health care. Too many managed care organizations are comfortable with the status quo.
The time may finally be here for standalone continuous glucose monitors. It's been a long road. Medicare and consumer health plans were slow to cover them, but now the FDA has approved four such devices. Experts expect t...The time may finally be here for standalone continuous glucose monitors. It's been a long road. Medicare and consumer health plans were slow to cover them, but now the FDA has approved four such devices. Experts expect that nearly 3 million Americans will be able to use the devices.
Zachary Hafner: "For the December 2017 issue of Managed Care, I wrote a piece titled, 'Better for Patients, or Better for Business-Do We Really Have To Choose'? I put forward several predictions related to key trends for...Zachary Hafner: "For the December 2017 issue of Managed Care, I wrote a piece titled, 'Better for Patients, or Better for Business-Do We Really Have To Choose'? I put forward several predictions related to key trends for 2018. Now that we have reached the midpoint of the year, it is a fitting time to check in and see how accurate those predictions have been."
The pipeline for gene therapies is flush. Clinical-Trials.gov lists 721 gene therapy trials. Last year, the FDA received 106 new drug applications for gene therapies, up 34% from 2016. There is no shortage of diseases fo...The pipeline for gene therapies is flush. Clinical-Trials.gov lists 721 gene therapy trials. Last year, the FDA received 106 new drug applications for gene therapies, up 34% from 2016. There is no shortage of diseases for gene therapies to target. But the costs of these therapies will break the bank.
Genetic tests are all the rage, but insurers are well aware of the downside. Genomics is complicated, and test results are often couched in uncertainty and loaded with caveats. The tests available to consumers may not be...Genetic tests are all the rage, but insurers are well aware of the downside. Genomics is complicated, and test results are often couched in uncertainty and loaded with caveats. The tests available to consumers may not be clinical quality, so if something questionable pops up, the tests need to be redone anyway. A positive result could also lead to a cascade of additional, expensive, and potentially risky diagnostic tests.
Aimovig (erenumab-aooe), codeveloped by Amgen and Novartis, has been recently approved for the prevention of migraines. Its mechanism of action is different than other migraine medications. But perhaps more interestingly...Aimovig (erenumab-aooe), codeveloped by Amgen and Novartis, has been recently approved for the prevention of migraines. Its mechanism of action is different than other migraine medications. But perhaps more interestingly, it is the first drug recently developed specifically for migraine prevention.
A report from the Hutchinson Institute for Cancer Outcomes Research is remarkable. Committing to transparency as a catalyst for improvement, 27 hospital systems and cancer centers across Washington State bare all in the...A report from the Hutchinson Institute for Cancer Outcomes Research is remarkable. Committing to transparency as a catalyst for improvement, 27 hospital systems and cancer centers across Washington State bare all in the first public report to integrate clinic level quality and cost data in oncology.
After years of court challenges, agency-imposed fines, and drugmaker lobbying, those restrictions on off-label marketing are loosening up. The agency is working on revisions to rules that govern how drug companies and th...After years of court challenges, agency-imposed fines, and drugmaker lobbying, those restrictions on off-label marketing are loosening up. The agency is working on revisions to rules that govern how drug companies and their sales representatives can communicate with doctors and payers about off-label use.
PURPOSE: To characterize subjects with chronic obstructive pulmonary disease (COPD) newly initiated on long-acting muscarinic antagonists (LAMA) or dual LAMA/long-acting β2-adrenergic agonist (LABA) therapy. DESIGN: This...PURPOSE: To characterize subjects with chronic obstructive pulmonary disease (COPD) newly initiated on long-acting muscarinic antagonists (LAMA) or dual LAMA/long-acting β2-adrenergic agonist (LABA) therapy. DESIGN: This pilot/preliminary analysis was a retrospective crosssectional study of subjects with COPD from the Optum Impact National Managed Care Benchmark Database. METHODOLOGY: Subjects with at least one LAMA prescription in the index period (July 2008-June 2009) were included and stratified by treatment. Data were collected in the year before the index date and included comorbidities, medication use, COPD-related costs, health care resource use, and exacerbations. RESULTS: Of 5,311 eligible subjects, 2,057 initiated LAMA therapy (LAMA cohort) and 191 initiated LAMA+LABA therapy (LAMA+LABA cohort). The Charlson comorbidity index was slightly lower in the LAMA+LABA cohort than the LAMA cohort (mean±SD: 0.63±1.13 vs. 0.66±1.28), but the number of prescriptions was higher (mean±SD: 42.9±23.2 vs. 30.5±27.2). The LAMA+LABA cohort had higher short-acting inhaled β2 agonist (56.0% vs. 35.7%), oral corticosteroid (37.7% vs. 32.6%), and home oxygen therapy use (14.1% vs. 3.2%) than the LAMA cohort. Total medical costs were greater in the LAMA+LABA cohort than the LAMA cohort (mean±SD: $3,320.40±4085.9 vs. $1,226.20±3602.9), although emergency department ($11.00±66.8 vs. $30.70±259.2) and outpatient visit ($39.60±163.1 vs. $41.70±424.3) costs were lower. Resource use and exacerbation incidence were similar between cohorts. CONCLUSION: In this first look, subjects with COPD initiating LAMA or LAMA+LABA therapy exhibited different clinical and resource use characteristics in the year before treatment. Subjects receiving LAMA+LABA were older, with higher COPD co-medication use, more prescriptions, and associated higher pharmacy costs compared with subjects initiating LAMA. These differences may reflect a higher severity of COPD in those starting LABA+LAMA treatment.
The breast cancer mortality rate in 2012 declined 49% compared with the expected baseline, and 63% of that reduction was from treatment drugs. You'd think that patients would take their cancer medicines no matter what. B...The breast cancer mortality rate in 2012 declined 49% compared with the expected baseline, and 63% of that reduction was from treatment drugs. You'd think that patients would take their cancer medicines no matter what. But when cost sharing reached between $100 and $500, the abandonment rate soared to 32%.
On the one hand, the PCMH is an admirable effort to gather in one place all the disparate and disorganized clinical and social supports the patient needs. At the same time, though, medical homes employ provider-defined b...On the one hand, the PCMH is an admirable effort to gather in one place all the disparate and disorganized clinical and social supports the patient needs. At the same time, though, medical homes employ provider-defined business models and conventional performance measures, belying the patient-centered in the name.
It's no mystery why this country has both the highest per capita health care costs and the lowest overall percentage of people with coverage. The two are connected, but as if on a teeter-tooter: As one goes up, the other...It's no mystery why this country has both the highest per capita health care costs and the lowest overall percentage of people with coverage. The two are connected, but as if on a teeter-tooter: As one goes up, the other goes down.
Sometimes patients are angry. Sometimes it is a symptom of their illness. Either way, nurses are on the front lines of health care and bear the brunt of the physical and verbal abuse from patients; gender may be a factor...Sometimes patients are angry. Sometimes it is a symptom of their illness. Either way, nurses are on the front lines of health care and bear the brunt of the physical and verbal abuse from patients; gender may be a factor. In California, hospitals and other health care providers are now required to keep a log of violent incidents and develop violence prevention plans. Federal legislation has been introduced.
At last count, the pharmaceutical industry's new product pipeline included more than 7,000 products in late-stage development, roughly half of which are deemed "specialty." The reality is, our health care system is poorl...At last count, the pharmaceutical industry's new product pipeline included more than 7,000 products in late-stage development, roughly half of which are deemed "specialty." The reality is, our health care system is poorly equipped to address this issue head-on.
The deadliness of liver cancer is undisputed, but a growing body of data shows that too often, patients, and particularly those who are uninsured or nonwhite, miss out on earlier diagnosis and potentially life-saving sur...The deadliness of liver cancer is undisputed, but a growing body of data shows that too often, patients, and particularly those who are uninsured or nonwhite, miss out on earlier diagnosis and potentially life-saving surgery.
Varying drug prices by indication could be an important value-based strategy in oncology, where multiple indications are becoming the rule. But will administrative costs offset any benefit? And legal and regulatory obsta...Varying drug prices by indication could be an important value-based strategy in oncology, where multiple indications are becoming the rule. But will administrative costs offset any benefit? And legal and regulatory obstacles could get in the way.
The drugs often are more effective and have fewer side effects. The science-often just amazing. Medically, cancer treatment has never been in a better place. But are high prices making it unaffordable? Payers, providers,...The drugs often are more effective and have fewer side effects. The science-often just amazing. Medically, cancer treatment has never been in a better place. But are high prices making it unaffordable? Payers, providers, policymakers, and drugmakers themselves are wrestling with the issue. Meanwhile, many patients are being priced out of treatments that could save their lives.