News

Washington, D.C. - The high court heard arguments last month in a case(Kentucky Association of Health Plans vs. Miller) charging that a Kentuckystate any-willing-provider (AWP) law violates the Employee Retirement IncomeSecurity Act (ERISA).

Delnor-Community Hospital in Geneva, Ill., wanted to become a national leader in patient satisfaction, as well as the first choice in its primary market. In achieving its goal, Delnor was challenged by the same issues many healthcare organizations are experiencing today, including staff retention and patient/customer satisfaction.

Dartmouth's Dr. John E. Wennberg describes this enemy of efficient healthcare and his plan to defeat it

Plan members evaluate cost and benefit trade-offs and learn the lessonsof value purchasing

Washington, D.C. - The high court heard arguments last month in a case(Kentucky Association of Health Plans vs. Miller) charging that a Kentuckystate any-willing-provider (AWP) law violates the Employee Retirement IncomeSecurity Act (ERISA). Kentucky insurers urged the Supreme Court to overturna lower court decision that the state law regulates insurance and thus isnot subject to the ERISA preemption. The managed care community maintainsthat the proliferation of AWP laws is undermining their ability to controlcosts and hopes that the U.S. Supreme Court will issue a strong ruling thisspring to curb this trend.

as reported January 1, 2003

J Russell Teagarden, MA, RPh, vice president of clinical practices and therapeutics at Medco Health Solutions in Franklin Lakes, NJ, explains how using an ?ethical template? for pharmacy benefit decisions can make those decisions consistent and fair, reducing patient displeasure, conflict, and litigation.

Psychostimulant drugs have consistently demonstrated efficacy in the treatment of attention-deficit/hyperactivity disorder (ADHD). Innovative technology has fueled the development of novel release mechanisms and isolation of active enantiomer components with the hopes of enhancing the duration of action and improving the safety and effectiveness. As a result, several new stimulant agents have recently been added to the arsenal of ADHD treatment options. Formulary selection is complicated by the high costs and small but distinct differences among these agents. The five newest FDA-approved stimulant agents for the treatment of ADHD are detailed, and a brief summary of future treatment options, including a recently approved nonstimulant agent, is provided.

If asked, could you present the underlying rationale for your pharmacy benefit coverage decisions? When considered from the consumer or employee perspective, why should they consider the payors or providers of their drug benefit legitimate decision-makers in limiting their healthcare policies?

Duloxetine is a reuptake inhibitor at serotonergic and noradrenergic neurons and appears to have low affinity for other neurotransmitter systems. In three published clinical trials in patients with MDD, duloxetine was well tolerated and more effective than placebo. Further study is needed to compare its efficacy with that of other antidepressants, to prospectively assess time to onset of antidepressant effect, and to clarify effects on somatic symptoms and potential adverse cardiovascular and sexual effects. Duloxetine is also under investigation for the treatment of stress urinary incontinence in women (trade name to be determined, comarketed by Lilly and Boehringer Ingelheim). Preliminary information suggests that duloxetine therapy reduces the number of incontinence episodes. Duloxetine has been deemed ?approvable? for the treatment of MDD and will be comarketed under the trade name Cymbalta by Eli Lilly and Company and Quintiles.

Pilot results in total savings of $1.50 per member per month, which couldadd up to millions in the long run

Consumer-directed healthcare warrants choice, control, customer satisfaction,among others

Ranked by consumer response to NRC study, 2002

If numbers don't lie, why don't we use them more often to manage? This is the question being asked by healthcare executives exposed to the emerging promise of Six Sigma management methodologies.

As a former college athlete, Daniel J.Hilferty, president and chief executive officer of AmeriHealth Mercy/Keystone Mercy in Philadelphia, knows how critical teamwork is. Teammates are especially helpful when dealing with complicated healthcare issues, such as serving the Medicaid population.

Your benefits program may qualify as a health plan that&s subject to federal regulations that took effect in October. Check your status, review your options and get ready for the next wave?privacy and security rules?in the spring.

With the threat of bioterrorism, there was a need to reintroduce a smallpox vaccine. FDA has now approved this dried, calf lymph-type vaccine.

Successful management of migraine attacks and their symptoms leads to economic benefits such as decreased reliance on healthcare resources, decreased employee absenteeism, and increased productivity. Appropriate treatment includes prophylaxis with lifestyle changes and drug therapy, and acute therapy with drugs. Over-the-counter analgesics can be effective acute therapy for mild migraine; for moderate to severe attacks, the 5HT1B/1D agonists, or triptans, offer significant efficacy and cost-effectiveness.

Ezetimibe (Zetia), approved in late October, represents the first new class of cholesterol-lowering drugs in 15 years. Ezetimibe, an intestinal cholesterol absorption inhibitor, has a unique mechanism of action, distinct from those of statins and bile acid sequestrants. When used as monotherapy, ezetimibe lowers low-density lipoprotein cholesterol (LDL-C) levels up to 18.5%. Coadministration of ezetimibe with statin therapy reduces LDL-C levels up to an additional 22%. The article reviews ezetimibe?s chemistry, pharmacology, pharmacokinetics, and clinical trial results.

As costs continue to rise, perhaps we should focus less on our expensesand more on our priorities

Streamlining helps MCOs meet their responsibilities in tedious credentialing tasks

Electronic prescription transmission can improve efficiency, reduce costs and enhance patient safety

Ranked by total of all payers, 2001

Dr. Mark W. Banks is well aware that physicians nationwide sometimes get frustrated with managed care. The CEO of Blue Cross and Blue Shield of Minnesota, a former practicing physician himself, saw the changes coming in the mid-1980s.

The Journal of the American Hospital Assn. voted it one of the most wired hospitals in the United States for the third consecutive year, but it's not backing off its investment in information technology. Northwestern Memorial Hospital has been operating in its new, $258 million facility since 1999.

Individual people and circumstances have different needs, and MCOs need to be flexible enough to meet them all

He's president of Evergreen Re, a managed-care consulting firm and reinsurance broker. Evergreen&s annual survey of the finances of managed care prompted a wide-ranging conversation from capitation to IT investments to inappropriate transplants.

Pipeline Preview for November

Microbial resistance is a concern in treating urinary tract infection (UTI) and bacteremia. But analysis of data from more than 200 US hospitals in the Surveillance Network Database-USA from 1999 to 2001 demonstrated bloodstream and urinary tract isolates with the potential to cause urosepsis to be very susceptible in vitro to broad-spectrum b-lactams and aminoglycosides. The study results were reported at the 42nd Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in San Diego, CA.

Studies presented at the Third European Stanley Foundation Conference on Bipolar Disorder in September in Freiburg, Germany, show two newer antipsychotics are each more effective than standard therapy for preventing mania relapse or reducing symptoms.