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Case Study: Turn data into knowledge.

Case Study: Compass Health is the state's largest provider of comprehensive behavioral health programs for children and adults from a variety of income levels and ethnic cultures.

Specialty pharmaceutical drug coverage by managed care plans

Heal thcare is in desperate need of disruption. Much of our nation's innovation spending is directed at the most complex, challenging and sophisticated problems in healthcare. Much less is being spent on learning how to provide the healthcare that most of us need, most of the time, in a way that is simpler, more convenient and less costly.

Healthcare is an industry perhaps more complex, fragmented and difficult to comprehend than any other. When we try to understand the dynamics that make our industry such a challenge in which to work, we inevitably underestimate the impact of one force or overlook a series of other competing agendas altogether. It's a slippery slope to think we can understand it all, let alone control it.

In a case that likely will be appealed, a San Antonio jury recently awarded $7.4 million in actual damages resulting from the alleged negligence by a health maintenance organization and several providers. In the lawsuit, a deceased woman's family accused Humana, two physicians, and a physician practice group of negligence in a wrongful death action. The jury decision resulted from a three-week trial presided over by a Republican-appointed judge with an insurance defense background. In accordance with Texas law requiring the apportionment of liability, the jury found Humana liable for 35% of the actual damages and the entire $1.6 million in punitive damages.

Last Month brought us news of the indescribable aftermath of Hurricane Katrina. I consumed all the information I could find at first, but then, like many Americans, I had to step away from the media for a while. I had to let the reality sink in without the narration of a news anchor.

Summarizing the Healthcare industry and the state of the precarious union between providers and payers is like trying to balance a gallon of fresh gelatin in your hands. Every time you think you've got it all together, it begins to slip to one side or right through your fingers. Healthcare is an industry perhaps more complex, fragmented and difficult to comprehend than any other. When we try to understand the dynamics that make our industry such a challenge in which to work, we inevitably underestimate the impact of one force or overlook a series of other competing agendas altogether. It's a slippery slope to think we can understand it all, let alone control it.

Small towns are known for close-knit communities, home cooking and home-grown enterprise. In Champaign-Urbana, Ill., even the CEO of the local managed care plan is a hometown native. Jeff Ingrum grew up in the Champaign area and says he never saw himself as the CEO of any health plan other than Health Alliance because of his long-standing familiarity with the people, the providers and the community.

This NSAID is believed to exert its therapeutic effect through inhibition of prostaglandin synthesis, primarily via inhibition of cyclooxygenase-2 (COX-2). Celecoxib was approved on July 29, 2005, for the relief of the signs and symptoms of ankylosing spondylitis (AS).

Review of agents in late-stage development for the treatment of epilepsy and migraine (September 2005).

Muraglitazar (Bristol-Myers Squibb/Merck) is a new agent under investigation for the treatment of patients with type 2 diabetes. It belongs to a novel class of drugs that target the peroxisome proliferator-activated receptors, both alpha and gamma subtypes. Available clinical data describe improvements in glycemic parameters similar to available thiazolidinediones. In addition to improvements in blood glucose and hemoglobin A (HbA 1c), muraglitazar treatment is associated with a substantial reduction in triglycerides (TGs), an increase in HDL-C, and a modest decrease in LDL-C levels. Safety data are limited, but in available abstracts, there are reports of moderately elevated rates of edema, weight gain, and hypoglycemia with muraglitazar compared with placebo or pioglitazone. When used in combination with metformin or glyburide, chronic heart failure events have been reported with muraglitazar. If approved, muraglitazar will provide a convenient alternative for the treatment of type 2 diabetes. (Formulary. 2005;40:285–293.)

One year of bisphosphonate therapy maintains the gains in bone mineral density (BMD) experienced after 1 year of full-length parathyroid hormone (1–84) in postmenopausal women at risk of osteoporotic fracture. The findings were published in the New England Journal of Medicine (2005;353:555–565).

This study compares the cost-effectiveness of the 4 most common empiric antimicrobial regimens used for the treatment of adults with community-acquired pneumonia (CAP) at a community health system during a 6-month period. Associations between initial antimicrobials and total hospital costs were determined. Cost-effectiveness ratios were determined by dividing the total hospital costs by the percent survival. A total of 415 patients met criteria for the Pneumonia Severity Index (PSI) risk class IV or V. Costs (adjusted for inflation) were as follows (median, 25th and 75th percentile): total hospital costs ($5,078 [$3,218–$8,144]), pharmacy costs ($753 [$455–$1,357]), and antibiotic costs ($139 [$82–$229]). The most favorable cost-effectiveness ratio was observed for patients who received levofloxacin monotherapy ($4,635 per life saved), followed by ceftriaxone plus a macrolide ($5,278), ceftriaxone monotherapy ($5,368), and ceftriaxone plus levofloxacin ($6,317).

Desmopressin tablets 0.1 and 0.2 mg (equiv to DDAVP tablets).

Pioglitazone acts primarily by decreasing insulin resistance, while metformin improves glucose tolerance in patients with type 2 diabetes, lowering both basal and postprandial plasma glucose.

Valsartan (Diovan, Novartis) received an expanded indication for reducing cardiovascular mortality in patients who are at high risk due to left ventricular failure or dysfunction after myocardial infarction.

This NSAID is believed to exert its therapeutic effect through inhibition of prostaglandin synthesis, primarily via inhibition of cyclooxygenase-2 (COX-2). Celecoxib was approved on July 29, 2005, for the relief of the signs and symptoms of ankylosing spondylitis (AS).

If managed care organizations are doing their homework and reading the statistics, they would know that conscientiously marketing specific services to the Hispanic population would reap a rich pay-off. Hispanics are the fastest growing group in the country; the U.S. Census Bureau estimates that after 2020, Hispanics will add more people to the U.S. population every year than all other race/ethnic groups combined.

Services being provided by PPOs and percentage of plans offering

Services being provided by PPOs and percentage of plans offering

New pharmacy systems are emerging that allow for deeper analysis

More professional workers are needed to serve larger numbers of people

Plans and enrollees reach compromise

If managed care organizations are doing their homework and reading the statistics, they would know that conscientiously marketing specific services to the Hispanic population would reap a rich pay-off. Hispanics are the fastest growing group in the country; the U.S. Census Bureau estimates that after 2020, Hispanics will add more people to the U.S. population every year than all other race/ethnic groups combined.

Mild to moderate psoriasis is generally treated first with topical corticosteroids and other topical remedies. When the disease is widespread or unresponsive to topical agents, ultraviolet phototherapy may be used at home or in the physician's office.

Change the culture. Turn things around. Start fresh. There are dozens of catch phrases for describing what the four healthcare CEOs featured in this month's Executive Profile did to redefine their respective companies.

In Some Parts of the United States, health plans have observed a growing trend of hospital-based provider groups, such as radiologists, pathologists, anesthesiologists, and emergency room physicians refusing to contract with health benefit plans. When a health plan enrollee seeks services from an in-network hospital in order to obtain lower out-of-pocket costs (for a PPO product) or full benefits (for an HMO product), the enrollee can be hit with a large, unexpected bill from the provider.

Women's trust in public ratings.

Phase 3 clinical trial results have demonstrated that the dual alpha/gamma peroxisome proliferator-activated receptor (PPAR) agonist muraglitazar achieves significant beneficial lipid effects compared with pioglitazone, and the agent also provides long-term glycemic control in type 2 diabetics. The results were reported during the American Diabetes Association (ADA) 65th Annual Meeting in San Diego, Calif.