Managed Care - January 2008 - (Page 12) NEWS AND COMMENTARY Too Few Programs to Manage MS? Disease management programs for patients with multiple sclerosis improve outcomes and adherence, reduce disability, and contains cost, but there are not enough of them in existence. That’s the main finding of a study by the National Multiple Sclerosis Society and Teva Neuroscience in which 82 managed care executives were polled. (Teva Neuroscience is the manufacturer of glatiramer acetate, trade name Copaxone, a treatment for MS.) The study also found that: • Only 8 percent of plans have a mature disease management program for MS in place, and less than half have a partially developed disease management program for MS. • Of the MCOs that participated in the research, 90 percent currently contract with specialty pharmacies and 79 percent indicated that their members with MS will be required or encouraged to use a specialty pharmacy to obtain injectable drugs within the next two years. • Insurers tightly control — through prior authorizations or moratoriums — new molecular entities, especially those in competitive categories or those whose use is largely off label. Wellness… … no longer just an add-on Cigna, Aetna, United HealthCare, and a host of Blues plans across the country intend to make wellness a major focus this year. So do we. Our February issue will look at the many facets of this accelerating drive. We’ll look at: • How health plans are becoming involved. Do they have to change their business model? How are they integrating wellness with DM and case management? Wellness would seem to be a natural for consumerdriven health care. Is it? • Evaluating the programs. How do you determine whether a program is useful, and who makes that judgment? • Employer involvement. They’ve been pushing wellness for years, but doing so with even more intensity lately. How are health plans responding? Are they taking advantage of this opportunity? • Legal concerns. Just how far will companies and plans go to encourage/mandate that employees get with these programs? High participation is needed to really make these programs work, but there has been some pushback. The U.S. Equal Employment Opportunity Commission is investigating whether wellness programs violate the Americans with Disabilities Act. • Exemplary programs. Who does it well? Headlines on Deadline Private insurers paid $272 billion in hospital charges in 2005, according to “National Hospital Bill: Growth Trends and 2005 Update on the Most Expensive Conditions by Payer,” a report issued by the Agency for Healthcare Research and Quality. The total 2005 hospital bill, which is adjusted for inflation, was $874 billion and accounted for 39 million hospital stays. The average yearly rate of increase in the national hospital bill over the last several years was 4.5 percent. At this rate, researchers estimate that the annual national hospital bill may reach $1 trillion in 2008 Health Level Seven, America’s Health Insurance Plans, and the Blue Cross & Blue Shield Association announced that they have agreed to create a collaborative process to maintain portability standards for personal health records. The group contends that the more stakeholders involved in developing and approving portability standards, the more easily plan members will be able to move their personal health data when coverage changes More than half (53 percent) of health care payers surveyed in “Financial Transparency: Health Care Payer Strategies and Execution, 2007– 2009” planned no additional investment in transparency initiatives in 2008. Instead, health care payers will assess the effectiveness and return on current transparency initiatives to identify best-practice industry models. Key initiatives include creating electronic access to information; improving data and information processes; consolidating data sets to produce accurate, reliable data sources; and adopting standards. — Tony Berberabe Next month in 12 MANAGED CARE / JANUARY 2008
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.