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IHN longevity

Kaiser Family Foundation Health Poll Report

Collective bargaining for better prices is among the many valuable benefits of creative partnering

Points to consider with plan beneficiaries and physician compensation arrangements

by degree of integration and performace level, 2003

When Destiny Health Plan launched its consumer-driven healthcare solution in the United States in 2000, it wasn't a shot in the dark. Its parent company, Discovery Health, headquartered in Johannesburg, had already proven the consumer-driven model's success in South Africa 10 years before. With a little tweaking to fit the U.S. marketplace, the healthcare product has taken off, serving 23,000 members and 700 employer groups.

We all remember how difficult things got for the managed care industry in the mid-to-late 1990s, but as they say: When the going gets tough, the tough get going.

Alzheimer's disease currently has no cure and is estimated to cost in excess of $100 billion per year.

Long-term treatment of 384 adults ADHD patients with atomoxetine (Strattera, Lilly) showed that 67% responded with at least a 30% improvement and 40% had at least a 50% improvement.

Metformin use in hospitalized patients is inappropriate more than one-third of the time.

Premeal dosing of inhaled insulin may represent a valuable option for patients with type 2 diabetes.

Approved for pediatric chronic myeloid leukemia

Treatment and prevention of osteoporosis

Panic disorder is the most common anxiety disorder in the primary-care setting. It is characterized by episodes of acute, unexpected, and unprovoked anxiety and is often associated with depression and/or agoraphobia. Symptoms may become so pervasive that many life situations may be avoided. Management of panic disorder includes cognitive behavioral therapy, patient education, and pharmacotherapy. This article focuses on the rationale of drug therapy, methods of management, and other clinical considerations such as side effects. In addition, newer formulations are available that may subsequently change how patients are managed. Selective serotonin reuptake inhibitors (SSRIs) are considered first-line therapy, with tricyclic antidepressants (TCAs) as a possible alternative if the patient fails to respond. These agents are also useful in the management of comorbid depression. Benzodiazepines offer more rapid anxiolysis and may be used in combination with an SSRI for bridging. Although monoamine oxidase inhibitors (MAOIs) have been studied, they do not have a significant role in the pharmacological management of panic disorder. (Formulary 2003;38:431?38.)

Nausea and vomiting are among the serious complications of chemotherapy and can be associated with medical and psychological complications. Palonosetron (Aloxi, MGI Pharma/Helsinn) is a new agent in the class of serotonin type 3 (5-HT3) receptor antagonists that have become a standard of care for the prevention of chemotherapy-induced nausea and vomiting. Palonosetron has a much longer half-life (~40 h) than typical 5-HT3 receptor antagonists and potentially improved efficacy in the prevention of delayed nausea and vomiting associated with moderately and highly emetogenic chemotherapy. Clinical trials of palonosetron in patients with cancer demonstrate its efficacy in the control of acute nausea and vomiting and its superiority to 2 agents in this class, dolasetron and ondansetron, in the control of delayed nausea and vomiting. Palonosetron is well-tolerated, with an adverse effect profile similar to other 5-HT3 antagonists. Its efficacy in the prevention of both acute and delayed nausea and vomiting makes palonosetron an attractive option for patients receiving chemotherapy. Further studies need to be conducted to determine the role of palonosetron among its competitors. (Formulary 2003;38:414?430.)

Formulary committees, pharmacy benefit managers (PBMs), pharmacists, and physicians face increased scrutiny of their relationships with pharmaceutical manufacturers under a final fraud policy statement from the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS).

Controlling the rate of growth in prescription drug expenses continues to be a challenge. The cost of offering healthcare insurance benefits, including prescription drug benefit programs, has increased to a rate of nearly 20% in 2003. Costs are expected to rise by double digits over the next 5 years. This daunting trend has influenced HMOs and other benefit providers to consider moving pharmacy benefit management in-house to cut costs.

With state governments hemorrhaging with budget deficits across the country,states have become equally focused on adopting and expanding Medicaid solutionson one hand, and generally cutting back on benefits on the other.

as of July 1, 2002

Providers and payers benefit from efficient scheduling,vbalanced utilization and adequate staffing

Ask hard-hitting questions about data security, backup and recovery when outsourcing IT functions

Physician plan executives tap into daily experiences to serve even the tiniest of members

There's an old fable about mortality where a man is granted one wish by a prophet. The man says, "I want to know where I'm going to die." Astounded, the prophet asks, "Why would you want to know that?" The man responds, "Because then, I'll never go there."

After attending the delivery of a baby in a community hospital in Louisville, Ky., Dr. Larry Cook paused for a moment in the hallway, still in his green hospital scrubs. The new baby's grandmother, a woman in her 50s, beaming with joy, approached Dr. Cook and threw her arms around him instinctively. Hugging him she said, "Dr. Cook, 21 years ago you attended the delivery of my daughter and provided her newborn care. And just now, you've attended the delivery of her child."

Seasonal allergic rhinitis is a disease characterized by sneezing, nasal congestion, rhinorrhea, and itching, conventionally treated with intranasal corticosteroids and antihistamines. The leukotriene receptor antagonist montelukast (Singulair, Merck) recently gained FDA approval for the treatment of seasonal allergic rhinitis. While studies have shown the efficacy of montelukast in the treatment of seasonal allergic rhinitis, there are no published clinical efficacy trials to date to support the use of montelukast alone or in combination with antihistamines as a superior therapy to intranasal corticosteroids in the management of seasonal allergic rhinitis. When combined with current economic considerations, the primary role of montelukast appears to be as an adjunct agent in patients whose seasonal allergic rhinitis symptoms cannot be controlled with intranasal corticosteroids or nonsedating antihistamines alone.

A new echinocandin, micafungin (Mycamine, Fujisawa), is currently under review for the treatment of systemic mycoses. If approved, micafungin would be the second agent in the echinocandin class available for use in the United States. It is believed to exhibit fungicidal or fungistatic activity against a variety of commonly encountered fungal pathogens including Candida and Aspergillus species. In addition to its broad spectrum of activity, initial clinical studies with micafungin have identified relatively few side effects and drug interactions. Micafungin exerts its antifungal activity at the level of the fungal cell wall via inhibition of 1,3 b?d-glucan synthase. Plasma concentrations follow a 2-compartment model with a half-life of 10 to 15 hours and a volume of distribution of 0.2 to 0.27 L/kg. Dose adjustments of micafungin due to hepatic or renal dysfunction appear to be unnecessary. Adverse events associated with micafungin are infrequently encountered and are generally mild in severity. Micafungin has been available in Japan since late 2002 and is also currently under review in Canada and Europe. Micafungin may offer advantages over other recently approved antifungal agents because of its excellent tolerability and minimal drug interactions.

DTR, June 2003

HMOs dropping out of M+C because of low payment rates

Instead of butting heads, health leaders can devise solutions that benefit everyone.

Health plans are going to look a lot different in the future, and the transformation needs to begin today.