Pediatrics

Telemedicine programs decrease time-to-diagnosis, save financial resources and reduce hospital stays.

Medicaid and uninsured as percent of pediatric emergency department* visits in certain markets, 2004

Pediatric emergency department visit growth by acuity and payer type, 2004

Drug Manufacturers have introduced vaccines for meningococcal disease, shingles, pertussis, rotavirus, and cervical cancer, meanwhile even more vaccines are in the development pipeline. While each represents a major step forward for public health, the advances present an assortment of challenges from payment rates for physicians to moral issues for parents.

About two hours after a colleague and I lamented over breakfast about Americans' shortcomings in wellness, I heard the news that the vaccine for human papillomavirus (HPV) had received the final nod from FDA. Now there was something Americans were actually doing pretty well: immunizing.

Childhood obesity and its inherent health risks have become a majorhealth crisis. Just a few decades ago, the idea of an obesityepidemic would have seemed inconceivable. As late as the 1960s and1970s, the rate of overweight children remained steady and nominal.By the mid-1980s, however, the numbers began rising and by the1990s, they were surging. In fact, obesity in children ages 6 to 11years has quadrupled the last 25 years and doubled for adolescents,according to the Centers for Disease Control.

All projections of rising healthcare costs assume that advances inmedical science will add to the cost. This is a reasonableassumption, since it has been uniformly true in the past.Antibiotics are a great advance, but bacteria develop resistanceand newer and more expensive antibiotics must be developed. Peoplewho would have died at home in the pre-antibiotic era now survive,but after the greater cost of antibiotics and, possibly,hospitalization. The same is true for advances in cardiac stents,cancer treatment, imaging with CT scanners and MRIs, etc. Thetechnology can be life-saving but is typically expensive.

If misery loves company, then Beverly Thomas of Carbondale, Ill.,isn't alone. She is one of thousands of dual eligibles(beneficiaries covered by both Medicaid and Medicare) who went tothe pharmacy after January 1, 2006, only to find that it would notfill their prescriptions. Unfortunately, her medication for mentalillness is so critical that if she misses even a day, she could behospitalized. With the help of Southern Illinois Regional SocialServices, Thomas got squared away, but admits she still is confusedabout how the new Medicare Part D benefit operates.

Most cost estimates for infertility treatment, including IVF, range from $4 to $6 per member per year.

EMRs can add to a practice's bottom line

Today's Approach to interventions that address chronic disease and conditions is both broader and deeper than ever before. But there is another group of patients who rarely, if ever, directly benefit from these programs. According to Alan Wright, MD, former chief medical officer of TheraCom, these are patients who might use more than $100,000 a year in pharmaceutical spending and/or resources, patients who have a disease that is progressive with no known cure. These are the patients who have a rare disease, such as pulmonary arterial hypertension (PAH), a rare blood vessel disorder characterized by increased pressure in the pulmonary artery.

If managed care organizations are doing their homework and reading the statistics, they would know that conscientiously marketing specific services to the Hispanic population would reap a rich pay-off. Hispanics are the fastest growing group in the country; the U.S. Census Bureau estimates that after 2020, Hispanics will add more people to the U.S. population every year than all other race/ethnic groups combined.

If managed care organizations are doing their homework and reading the statistics, they would know that conscientiously marketing specific services to the Hispanic population would reap a rich pay-off. Hispanics are the fastest growing group in the country; the U.S. Census Bureau estimates that after 2020, Hispanics will add more people to the U.S. population every year than all other race/ethnic groups combined.

Mild to moderate psoriasis is generally treated first with topical corticosteroids and other topical remedies. When the disease is widespread or unresponsive to topical agents, ultraviolet phototherapy may be used at home or in the physician's office.

Generics should get a large boost in the next few years as branded drugs accounting for more than $38 billion, including Prevacid, Prevachol, Zocor, Zoloft and Paxil, are expected to come off patent by the end of 2008. With the generic dispensing rate remaining under 42% over the past 10 years, there is room for improvement; savings of nearly 1% by plan sponsors for every 1% increase in the use of generics, according to Express Scripts.

The marketplace increasingly relies on multi-specialty DM companies, but one organization is pursuing a contrarian approach for disease management. Cypress, Calif.-based PacifiCare Health Systems is following what Gordon K. Norman, MD, its vice president for disease management, calls a "best of breed" strategy.

April FDA Pipeline

New molecular entities

Health literacy is the next frontier in effective delivery.

Providing hardware is not enough motivation; you need to add another incentive.

Providing hardware is not enough motivation; you need to add another incentive.

By withholding information about some antidepressant medications that cause an increase in suicidal tendencies among teenagers, the Food and Drug Administration (FDA) created heightened public concern about the value of antidepressants.

New indications

For the past several years, non-profit health plans and insurers have been converting to for-profit corporations (or have been acquired by for-profit enterprises) in an effort to gain access to capital markets, to expand their service area, and/or to add to their product lines. In most states, the Blue Cross Blue Shield plans are no longer non-profit.

FDA actions and new molecular entities

Wellness Inventory, a survey-based program developed by Pfizer Inc. and the MEDSTAT Group, has consistently found allergic rhinitis to have a significant impact on employee productivity and employer costs.

If diagnosing IBS is difficult, managing it can be even trickier because there’s no protocol.

HMOs can only grow by taking business from their competition or through acquisition

Washington, D.C. - Last month, the House approved legislation that would make it easier for Americans to obtain prescription drugs from Canada and other countries, similar to action it took last year. This time the legislators voted overwhelmingly to add to FDA's 2005 budget bill a provision that blocks FDA from enforcing a ban on drug reimportation. The drug import language is not expected to survive House-Senate negotiations on a final FDA spending bill, but it allows members of Congress to portray themselves as import advocates at election time.

NATIONAL REPORTS-MCOs are expected to soon treat pediatric drug costs in a similar manner to which they treat drug spending overall, according to industry experts.