2010 Potpourri XX

When Per Lofberg became head of the Caremark PBM division of CVS, it also invested in Generation Health, a genetic test manager, which Mr. Lofberg was running.  The notion, similar to Medco’s, was that, just as the PBM does with drugs, it would help manage the use of genetic tests that are ordered for health plan members and would possibly encourage ordering of some of those tests that are linked to use of particular drugs.  The companies issued a press release describing the initial set of tests they will offer to help guide drug prescribing.  (CVS Caremark Release) You know personalized medicine has begun to become a more significant part of day-to-day clinical medicine when payers and their intermediaries like the PBMs begin to be concerned about managing its use and taking advantage of its potential cost-reduction benefits.

CardioMEMS, a company which has produced a wireless, implantable heart monitoring device for heart failure patients, announced results of a three year study of the product.  (CardioMems Release) The study compared patients whose treatment was guided by pulmonary artery pressure readings obtained from the device versus those whose care was not.  The results indicate that using the device to guide therapy reduced hospitalizations by 30%.

It seems like not a week goes by without some truly shocking, just shocking, revelation about the process of getting the health care reform bill passed.  This week’s comes courtesy of the New York Times, of all places, and suggests that some of the numbers used to justify portions of the law might have been presented in a misleading fashion.  (NY Times Story) Really.  The data in question comes from the Dartmouth Atlas work, which the administration used to claim that there was as much as $700 billion in wasted spending on health care, spending which could be eliminated without affecting quality.  The Dartmouth work, however, has been questioned by other researchers and really doesn’t say much about quality.  The notion that a third of our spending is simply unnecessary is so obviously hogwash that it never should have been given any credibility to begin with.

One major use of telemedicine for many years has been in prison systems, where it is dangerous and costly to transfer patients to medical treatment facilities and often hard to get to providers to come to the correction facility.  A recent study indicates that providers utilizing telemedicine for prisoners in the Louisiana correctional system perceived that it allowed them to provide services effectively and to create satisfactory health outcomes.   (JTE Article)

A New England Journal of Medicine Perspective discusses the role of community health centers following reform.  (NEJM Perspective) The community health centers were initially begun as a gap-filler for areas, usually either poor urban regions or underserved rural locations, to ensure access to basic health care.  They have by all accounts done an excellent job of fulfilling that mission.  Both the previous and current Administration have significantly expanded funding for these centers.  They are still amazingly cheap for what they accomplish.  In fact, rather than expanding Medicaid at an exorbitant price, more bang for the buck could likely be achieved by greater utilization of the community health centers.

More good reform news–insurance premiums are going up rapidly!  Isn’t that what we were promised?  (CIAB Survey) The Council of Insurance Agents and Brokers released results from a survey on 2011 renewal rates.  They indicate that most employers are seeing significant price increases for renewals, many in the double digit range.  Employers are reacting by reducing benefits or continuing to shift cost to employees.