2010 Potpourri XXII

One sure way to get people to adopt a desired behavior is to pay them to do it.  The New York Times has an article describing a program which does just that to get people to take their drugs.  A significant percentage of prescriptions are not even filled, frequently because of cost or fear of adverse effects.  Others are filled but the patients don’t take the drugs as often or when they are supposed to.  The program used a computerized pillbox to track use and enter patients into a lottery in which they could win money for sticking to their prescription.  One concern is whether people will stop complying if they are no longer paid.  (NY Times Story)

Aetna and Intel described preliminary results from a study utilizing Intel’s Health Guide monitoring product for heart failure patients.  According to the release, use of the real-time monitoring program allowed earlier and more frequent intervention on health issues and appears to have improved patient compliance with medication and other medical instructions.  Full results will be released later this year.  (Aetna Release)

The FDA has issued warning letters to several makers of consumer-oriented genetic testing services.  The letters are fairly brief and basically state that the testing service is a device because it is intended for use in the diagnosis of disease or in the cure, mitigation or prevention of disease.  The FDA also says the laboratory developed test exception doesn’t apply since the test is used at more than one lab.  (FDA Letters) For some time regulatory experts have been warning that these genetic testing services appeared to be ignoring the possibility that the FDA requirements applied to them.  This should be an opportunity to create a rational set of rules to guide use of these services.

Calpers is advising state employees to expect significant health insurance cost increases next year.  (Calpers Story) The increases will average 9% and be as high as 16%.  Calpers covers 1.3 million and has substantial bargaining clout with insurers, but this was the best they could do.  Calpers attributes the increases to providers increasing prices, not to greater utilization.  The story points out that these increases are inconsistent with the promises made by the Administration in regard to the effect of the new law.

John Goodman issued a brief analysis suggesting that emergency room use will expand dramatically under the new federal health law.  Drawing partly on the experience in Massachusetts and on studies of ER use, he projects as many as 40 million new visits a year, visits the system is obviously ill-prepared to handle.  The primary reasons are that many of the newly covered individuals will be in Medicaid, which pays physicians very poorly and makes finding a doctor hard, so Medicaid patients often go to the ER.  In addition, there simply is not enough physician supply to handle all the new demand.  (ER Visit Analysis)

According to a Wall Street Journal article, Medicare could save about $500 million a year by approving the use of the drug Avantis for treatment of macular degeneration.  The competing product, Lucentis, is far more expensive.  Avantis is already more widely used by physicians and apparently produces as good or better outcomes.  This is a prime example of why government health programs are viewed with suspicion by many.  They are just ineptly run.  (WSJ Article)