2010 Potpourri XXVI

Last week I know you all missed not having a Massachusetts update, so we have one again this week.  The Boston Globe reports that the failure of the reform law there to reduce costs, and in fact to potentially increase them, has led to higher small business insurance rates and the small businesses in turn are telling employees to go get coverage in the individual market, which is subsidized by the state.  This will cause even greater deficit issues for the state government.   The penalty for not providing coverage is orders of magnitude less than the cost of health insurance and the federal law will impose even lower penalties when it kicks in.  The day of reckoning is fast approaching.   (Boston Globe Story)

For years average wholesale price was the most common benchmark for drug pricing.  Due to manipulation of AWP, a judge made its future use difficult.  Many participants in the drug distribution and payment chain were looking for an alternative anyway, but an AIS story indicates that there is little agreement yet on what should replace AWP.  Medicare and the state Medicaid programs have used alternative pricing methods.  This is a significant issue because it affects the profits of everyone along the chain.   (AIS Story)

The National Venture Capital Association, in conjunction with Price Waterhouse, has released its quarterly summary of venture capital activity, covering the second quarter of 2010.   (NVCA Materials) Venture firms put about $65 billion in 906 deals in the second quarter, which was up 34% in dollars from the first quarter.  The first half of 2010 saw a 49% increase in dollar investments over the first half of 2009.  More money went to early stage companies, which is important for job formation.  Exits, particularly through IPOs, also improved.  Venture firm fundraising, however, was down, which has negative implications for future investments.

The Charleston Gazette reports on the Veterans Administration’s telehealth program, which is widely acknowledged to be successful.  The story describes a teledermatology program which both physicians and patients find convenient and time-saving.  It also discusses a care coordination effort for chronic disease patients using remote monitoring and telemedicine.  This program appears to have significantly reduced hospital days and ER visits for the veterans.   (News Story)

A study published in Lancet gives further evidence for the value of telemedicine.  In this study of several hundred patients in Great Britain, a self-management intervention for high blood pressure was tested against usual care.  The patients self-titrated medications and took their own blood pressure readings.  The blood pressure was monitored remotely by providers to identify any problems that the patients appeared to not be handling on their own.  The intervention group had better blood pressure control after one year and most of the patients preferred self-management.  Although no formal cost-effectiveness analysis was done, the patients used slightly more medications and had slightly fewer physician visits. (Lancet Study)

Recent research indicates that the Medicare Part D drug benefit is helping heart failure patients get more drugs.  Although the medications are important, they are also often expensive and many heart failure patients had poor compliance because they often didn’t even fill prescriptions.  The researchers found that after enrolling in a Part D plan, these patients filled 6 more prescriptions a year.  The study doesn’t do an economic analysis, but it would seem that the extra drug cost might be outweighed by savings in other areas.    (Am. Heart Journal Study)