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November DTR Chart: Top States by Medicare HMO enrollment

November DTR Analysis: Medicare HMO enrollment varies dramatically

As the spiraling cost of healthcare continues to strain federal and state budgets, state Medicaid agencies are looking for powerful, workable solutions to the crisis.

Several drug regimens are available for asthmatics, but the key to asthma control is to reduce airway inflammation, and therefore limit the need for short-term rescue medications.

Unfortunately, many providers can't squeeze much more money out of cost reductions.

PHCS President and CEO Joe Driscoll takes on healthcare's Big 3 with a proprietary PPO network.

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.

There has been a nationwide increase in the incidence of vancomycin-resistant Enterococcus (VRE) reported over the last decade and a half. The heightened concern caused by VRE and the possibility of vancomycin resistance gene transfer to other gram positive organisms, especially methicillin-resistant Staphylococcus aureus (MRSA), led the Centers for Disease Control and Prevention (CDC) and the Hospital Infection Control Practices Advisory Committee (HICPAC) to publish recommendations for the prevention and control of vancomycin resistance. However, in 2002, the first documented case of vancomycin-resistant S aureus (VRSA) was reported in Michigan in an immunocompromised patient with a history of diabetes, peripheral vascular disease, and renal failure. Since then, 2 other cases have been reported: 1 in Pennsylvania in October 2002 and 1 in New York in March 2004. The limited availability of effective antimicrobial agents against vancomycin-resistant strains of Enterococcus and Staphylococcus species and the morbidity, mortality, and cost associated with resistance represent serious reasons for concern. This article presents a general overview of the current literature on the prevention and control of vancomycin resistance and a review of potential antimicrobial agents used in the treatment of VRE, vancomycin intermediate S aureus (VISA), and VRSA infections.

Secondary hyperparathyroidism is a common sequelae of chronic kidney disease. Treatment of this condition with traditional agents such as phosphate binders and vitamin D analogs is often complicated by the development of hypercalcemia and hyperphosphatemia. Cinacalcet (Sensipar, Amgen) is the first agent in a new class of drugs called calcimimetics. The agent sensitizes the calcium-sensing receptors in the parathyroid gland to extracellular calcium and directly lowers arathyroid hormone levels. Cinacalcet is FDA-approved for the treatment of secondary hyperparathyroidism in patients with chronic kidney disease on dialysis. In this patient population, cinacalcet reduces plasma intact parathyroid hormone (iPTH) levels, serum calcium and phosphorus levels, and the calcium-phosphorus product without associated hypercalcemia and hyperphosphatemia. Cinacalcet appears to be well-tolerated, with nausea, vomiting, and hypocalcemia as the main adverse events. The drug is also approved for the treatment of hypercalcemia in patients with parathyroid carcinoma and holds promise for the treatment of primary hyperparathyroidism.

There is a chronic problem with the healthcare system in the United States and no shortage of rhetoric and theory on how to fix it. In the end, it comes down to a matter of focus.

Months before my grandmother moved into a nursing home, she called me over to her house to help in the kitchen.

Since the mid-1990s, most U.S. industries have begun to outsource inbound customer care as a cost control measure. The experience and sophistication of many outsourced service providers allow clients to achieve substantial cost savings, including minimizing capital expenditure for new technologies while maintaining the same or improved service levels.

Specialty drugs falling under pharmacy benefit

Medicare’s announcement of a 17% increase in premiums precipitated a more recent report that found that overall health care insurance costs jumped more than 11% in the last year, according to a survey by the Kaiser Family Foundation and the Health Research and Educational Trust. It didn’t take long for the pundits to take a direct shot at Medicare’s financing and, of course, that other easy prey-managed care.

On July 23, a joint report on the role of competition in healthcare was issued by the Federal Trade Commission and the Department of Justice. Covering a range of issues dealing with the cost, quality and accessibility of healthcare, the report was produced as the result of a two-year project conducted by the two agencies, which included over five weeks of joint hearings held in 2003.

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Specialty pharmaceutical coverage by managed care plans

Everyone's familiar with nonsteroidal anti-inflammatory medications (NSAIDs). These are household names, sold in every drugstore, and consumers use them for headaches, athletic injuries, and other minor aches and pains.

Managed care organizations, hospitals and providers evolve, responding to market influences, but some key issues still command attention.

A unique social HMO for Medicare eligibles, SCAN goes beyond medical benefits and is able to offer its members access to community-based services such as transportation, housecleaning and home-delivered meals-dessert included.

Months before my grandmother moved into a nursing home, she called me over to her house to help in the kitchen.

A telephone survey investigating comedication rates of aspirin, acetaminophen, or nonaspirin NSAIDs (ibuprofen and naproxen) among long-term cyclooxygenase 2 (COX-2) inhibitor users (at least a 90-day supply of a COX-2 inhibitor) (N=325, mean age 71, 67% female) revealed that 50% used aspirin concurrently despite its apparent GI adverse effects. Aspirin use was higher for those aged ?56 years (50%) than for those aged 37 to 55 years (25%) (P=.03).

The Warfarin/Aspirin Study in Heart Failure provided no evidence that aspirin is effective or safe in heart failure patients.

A study presented on August 25 at the 20th International Conference on Pharmacoepidemiology & Therapeutic Risk Management in Bordeaux, France, revealed that higher-dose rofecoxib (>25 mg/d) was associated with a greater risk of acute myocardial infarction (AMI) and sudden cardiac death (SCD) compared to other NSAIDs. The risk of AMI and SCD was also increased with lower-dose rofecoxib (25 mg/d) when compared with celecoxib. The maximum recommended daily doses of rofecoxib in the management of pain associated with osteoarthritis, rheumatoid arthritis, primary dysmenorrhea, and migraine attacks with or without aura are 25, 25, 50, and 50 mg/d, respectively.

A study presented on August 25 at the 20th International Conference on Pharmacoepidemiology & Therapeutic Risk Management in Bordeaux, France, revealed that higher-dose rofecoxib (>25 mg/d) was associated with a greater risk of acute myocardial infarction (AMI) and sudden cardiac death (SCD) compared to other NSAIDs. The risk of AMI and SCD was also increased with lower-dose rofecoxib (25 mg/d) when compared with celecoxib. The maximum recommended daily doses of rofecoxib in the management of pain associated with osteoarthritis, rheumatoid arthritis, primary dysmenorrhea, and migraine attacks with or without aura are 25, 25, 50, and 50 mg/d, respectively.

Once-daily injections of liraglutide, a long-acting, acylated, glucagon-like peptide 1 analog, have proven to be effective in the treatment of patients with type 2 diabetes.

Investigators in the Trial of Atorvastatin in Rheumatoid Arthritis (TARA) assessed whether statins would reduce inflammatory symptoms in patients with RA. Patients with RA (N=116) were randomized in the double-blind, placebo-controlled trial to receive 40 mg of atorvastatin or placebo in addition to their current disease-modifying antirheumatic drug (DMARD) therapy.

Epilepsy therapy approved for migraine prophylaxis