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The Year in Managed Care - 2000

DateJan, 2001
Pages341
Price / format€9363 / Hard Copy

€9 363 

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Abstract:
 The Year in Managed Care is a compendium of over 100 key articles published by the Genesis Report/MCx over the past year, this report provides a comprehensive point of view and in-depth perspective on topics and events of strategic significance to managed care and the rest of the industry.








Table of contents:
 THE YEAR IN MANAGED CARE – 2000

TABLE OF CONTENTS

SECTION 1 INTRODUCTION................................................................................................................................... 1
SECTION 2 DISEASE MANAGEMENT, THE CLINICAL CORE OF MANAGED CARE.................................... 3
2.1 OVERVIEW .............................................................................................................................................. 3
2.1.1 Disease Management Without Illusion: Positive Outcomes, Competitive Price.............................. 3
2.1.2 Not So New Kid on The Block......................................................................................................... 4
2.1.3 Setting the Stage: Accountability, Integration.................................................................................. 5
2.1.4 State of Disease Management: Where We Are, How We Got Here................................................. 8
2.1.5 “Nash’s Rules” for Successful Disease Management Programming.............................................. 10
2.1.6 The Future of Disease Management: Who Cares About All This Anyway?.................................. 13
2.2 DIABETES .............................................................................................................................................. 15
2.2.1 Perceptions And Perplexities Of Diabetes And Its Complications................................................. 15
2.2.2 There’s More To Diabetes Care Than Tight Glucose Control ....................................................... 34
2.2.3 Nurse Practitioners And PCPs May Fall Short In Diabetes Control .............................................. 54
2.2.4 Multiple Diabetes Test Package Only Looks Like A Glucometer ................................................. 56
2.3 DEPRESSION.......................................................................................................................................... 59
2.3.1 Perceptions And Misperceptions .................................................................................................... 59
2.3.2 PCPs, Parity, And Productivity – Figuring How It Will All Cost Out ........................................... 76
2.3.3 What’s Holding Back The Building Of Depression Management Programs? ............................... 97
2.4 LUNG CANCER...................................................................................................................................... 99
2.4.1 Vagaries of population screening to prevent a preventable disease ............................................... 99
2.4.2 Progress toward integrated care – But What Will Managed Care Accept? .................................. 123
2.4.3 Managed Care In Uneasy Dance With Lung Cancer Screening And Care .................................. 140
2.5 BREAST CANCER ............................................................................................................................... 153
2.5.1 Society Of Breast Imaging Shows Cost Effectiveness Of Mammography .................................. 153
2.5.2 ACS Disputes Danish Study, Affirms Value Of Mammography Screening ................................ 154
2.6 CERVICAL CANCER........................................................................................................................... 156
2.6.1 Screening Advances, But Will Managed Care Buy In?................................................................ 156
2.7 COLORECTAL CANCER ..................................................................................................................... 162
2.7.1 Enhancing Colorectal Cancer Awareness..................................................................................... 162
2.8 PAIN ..................................................................................................................................................... 163
2.8.1 The Many Faces Of Pain: Innovative Technologies Debut .......................................................... 163
2.9 OSTEOPOROSIS................................................................................................................................... 176
2.9.1 How Fragile is Her Future – Report Surveys Late Detection of Bone Loss................................. 176
2.9.2 Risk Testing: Gemini Holdings/Affymetrix – “One Time” Test Helps Lifetime Management ... 178
2.10 ALZHEIMER’S AND PARKINSON’S ................................................................................................. 179
2.10.1 Alzheimer’s And Parkinson’s In The Age Of Managed Care ...................................................... 179
2.10.2 Early Detection Of Alzheimer’s ................................................................................................... 194
2.10.3 Parkinson’s Disease – In The Wings: Promising Disease-Reversing Therapies .......................... 195
2.11 MULTIPLE SCLEROSIS ....................................................................................................................... 205
2.11.1 Better Drugs But No Cure In Sight .............................................................................................. 205
2.12 HIV/AIDS .............................................................................................................................................. 212
2.12.1 Treatment Guidelines: A Living Document ................................................................................. 212
2.12.2 Phenotypic Resistance Test Improves HIV Treatment Outcomes And Cuts Costs...................... 213
2.13 HOME MONITORING .......................................................................................................................... 215
2.13.1 FDA Gives Home System Class II Status .................................................................................... 215
SECTION 3 PHARMACY ISSUES – BENEFIT DESIGN, FORMULARIES, AND DRUG SPENDING............ 217
3.1 OVERVIEW .......................................................................................................................................... 217
3.1.1 What Drives the Formulary Process? Beyond Costs and Rebates to Outcomes........................... 217
3.1.2 Pharmacy Benefit Strategies Can Tame Unruly Drug Costs ........................................................ 217
3.1.3 Pharmacy Benefit Design: Three-Tier Option Gains Ground ...................................................... 218
3.1.4 Pharmaceutical Spending: Independent Data Sought on Drug Tradeoffs .................................... 218
3.1.5 Mail Service Pharmacy Well Received ........................................................................................ 218
3.1.6 McKesson HBOC Selected by Novartis to Provide Starter Supply Programs ............................. 219
3.2 WHAT DRIVES THE FORMULARY PROCESS? COSTS, REBATES…AND YES, OUTCOMES. 219
3.2.1 Executive Summary ..................................................................................................................... 219
3.2.2 Helping Physicians Write Rational Prescriptions......................................................................... 220
3.2.3 “It’s Not on the Formulary” ......................................................................................................... 222
3.2.4 Some Groups Take Back Control................................................................................................. 225
3.2.5 Pharmacologic Distinctions within a Class .................................................................................. 226
3.2.6 Some Plan-Group Alignments Dissolve....................................................................................... 228
3.2.7 Uniform Message with Manufacturers ......................................................................................... 229
3.3 PHARMACY BENEFIT STRATEGIES CAN TAME UNRULY DRUG COSTS ............................... 230
3.4 MANAGED CARE INCREASES USE OF THREE-TIER CO-PAYS.................................................. 242
3.5 MCKESSON HBOC SELECTED BY NOVARTIS TO PROVIDE STARTER SUPPLY
PROGRAMS.......................................................................................................................................... 243
3.6 INDEPENDENT DATA SOUGHT TO DEMONSTRATE DRUG TRADEOFFS ............................... 244
3.7 PATIENTS LARGELY SATISFIED WITH HOME RX DELIVERY.................................................. 247
SECTION 4 INTERNET INITIATIVES.................................................................................................................. 249
4.1 OVERVIEW .......................................................................................................................................... 249
4.1.1 Web-Enabled Decision Support: Better Care And Return on Investment? .................................. 249
4.1.2 Physicians and Drug Firms: Trapped in the Web, but Learning to Like It................................... 249
4.1.3 Watch This Space: E-Health Evolves Beyond Content to Care ................................................... 250
4.1.4 The Online Office......................................................................................................................... 251
4.2 WEB-ENABLED DECISION SUPPORT: GOOD OUTCOMES AND GOOD INVESTMENT ......... 252
4.3 PHYSICIANS AND DRUG FIRMS: TRAPPED IN THE WEB BUT LEARNING TO LIKE IT........ 260
4.4 WATCH THIS SPACE: E-HEALTH EVOLVES BEYOND CONTENT TO CARE ........................... 265
4.5 IS THERE A DOCTOR IN THE HOUSE? VIRTUALLY – LOOK TO THE COMPUTER................ 275
4.6 E-PHYSICIAN REPORTS RAPID ADOPTION OF INTERNET-BASED, PALM-SIZE
COMPUTERS........................................................................................................................................ 282
4.7 ALLSCRIPTS AND PLANET-RX.COM ALLIANCE LINKS EXAM ROOM AND INTERNET
PHARMACY......................................................................................................................................... 283
4.8 OPTION CARE LAUNCHES SPECIALTY PHARMACY AND E-COMMERCE DIVISION........... 284
4.9 WEB-BASED ANALYTIC PRODUCT LINKS DRUGS TO DIAGNOSIS......................................... 285
4.10 PALM DEVICE PUTS PHYSICIANS ONLINE ................................................................................... 286
4.11 CANCERPAGE.COM LAUNCHES WEB SITE OFFERING INDIVIDUALIZED SUPPORT .......... 288
SECTION 5 INFORMATION TECHNOLOGY...................................................................................................... 291
5.1 OVERVIEW .......................................................................................................................................... 291
5.1.1 Information Systems: The Life Blood of DM for High-Risk Populations ................................... 291
5.1.2 Profiling and Predictive Modeling to Support DM: Let the Data Speak ...................................... 291
5.2 INFORMATION SYSTEMS: THE LIFE BLOOD OF DISEASE MANAGEMENT FOR HIGH-RISK
POPULATIONS .................................................................................................................................... 292
5.3 PROFILING AND PREDICTIVE MODELING TO SUPPORT DISEASE MANAGEMENT: LET THE
DATA SPEAK....................................................................................................................................... 301
5.4 ELECTRONIC RECORDS EASE PAPERCHASE, BUT YOU CAN’T JUST “PLUG AND PLAY”. 311
SECTION 6 DIAGNOSTICS .................................................................................................................................. 321
6.1 OVERVIEW .......................................................................................................................................... 321
6.1.1 Managed Care Debate and Diagnostic Medicine ......................................................................... 321
6.1.2 Industry-Lab Consortium Envisions Smooth Point-of-Care Connectivity................................... 321
6.1.3 Infectious Disease: New Diagnostic Tools Improve Detection, Reduce Costs ............................ 322
6.2 EDITORIAL: MANAGED CARE DEBATE AND DIAGNOSTIC MEDICINE.................................. 322
6.3 INDUSTRY-LAB CONSORTIUM ENVISIONS SMOOTH POINT-OF-CARE CONNECTIVITY... 324
6.4 PCR TESTS FOR STD IMPROVE DETECTION AND REDUCE RELATED HEALTH-CARE COSTS
327
6.5 NEW RESPECT FOR SYSTOLIC BLOOD PRESSURE...................................................................... 328
SECTION 7 MILLENNIAL MUSINGS .................................................................................................................. 333

LIST OF FIGURES

Figure 2.1 Forecast for Arthritic Pain by Technology Type ............................................................................. 165
Figure 2.2 Forecast for Acute Pain by Technology Type.................................................................................. 168
Figure 2.3 Forecast for Chronic Pain by Technology Type .............................................................................. 171
Figure 2.4 Forecast for Migraine and Headache by Technology Type ............................................................. 173
Figure 2.5 Forecast for Neuropathic Pain by Technology Type ....................................................................... 175
Figure 2.6 Market Impact Matrix for Parkinson’s Disease ............................................................................... 202
Figure 2.7 Forecast for Parkinson’s Disease by Technology Platform............................................................. 202
Figure 2.8 Market Impact Matrix for Multiple Sclerosis .................................................................................. 209
Figure 2.9 Forecast Multiple Sclerosis by Technology Platform...................................................................... 210

LIST OF TABLES

Table 2.1 Symptoms Profile of Depression ....................................................................................................... 60
Table 2.2 Market Forecast by Technology for Depression................................................................................ 67
Table 2.3 Market Forecast for Lung Cancer by Technology Platform............................................................ 102
Table 2.4 Market Forecast for Pain.................................................................................................................. 164
Table 2.5 Market Forecast by Technology for Arthritic Pain .......................................................................... 166
Table 2.6 Market Forecast by Technology for Acute Pain .............................................................................. 169
Table 2.7 Market Forecast by Technology for Chronic Pain........................................................................... 171
Table 2.8 Market Forecast by Technology for Migraine and Headache.......................................................... 174
Table 2.9 Market Forecast by Technology for Migraine and Headache.......................................................... 176
Table 2.10 Number of Product Development Programs for Parkinson’s Disease ............................................. 198
Table 2.11 Forecast US Sales for Parkinson’s Disease Therapeutics by Technology Platform ($ Millions) .... 204
Table 2.12 Forecast Worldwide Sales of Parkinson’s Disease Therapeutics ($ Millions)................................. 204
Table 2.13 Multiple Sclerosis Active WW Programs by Technology Platform and Clinical Status ................. 207
Table 2.14 US Forecast Sales for Multiple Sclerosis Therapeutics by Technology Platform ($ Millions) ...... 212
Table 2.15 Forecast Worldwide Sales for Multiple Sclerosis Therapeutics 1999-2005 ($ Millions) ............... 212
Table 3.1 Components of Per-Member-Per-Year Average Wholesale Price Cost Trend 1995-1999.............. 233
Table 3.2 Tiers Are Here – Co-Pays Up .......................................................................................................... 243
Table 5.1 Analysis Claims Data Vs. Plan of Care ........................................................................................... 299




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