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What Drives Spending and Utilization on Medicaid Drug Benefits in States?

December 20, 2014 Comments off

What Drives Spending and Utilization on Medicaid Drug Benefits in States?
Source: Kaiser Family Foundation

Medicaid is one of the country’s biggest payers for prescription drugs, but because prescription drugs have accounted for a small share of total Medicaid spending, Medicaid’s pharmacy benefit policies have not been at the top of mainstream healthcare policy debate. However, with the approval of new specialty drugs, such as the Hepatitis C treatment Sovaldi, states are mindful that the price tag for the Medicaid drug program could increase significantly. While states have implemented many cost-saving policies targeting their Medicaid prescription drug benefits, there remains room for additional cost savings, better management, and improved health outcomes. To ensure appropriate policy for this central benefit and achieve these goals, it is important to understand which drugs are most frequently prescribed and which drive spending.

Using state drug utilization data, as well as an industry drug database, this issue brief examines trends in Medicaid drug prescriptions and drug spending before rebates from 2010 through 2012.1 As part of the Medicaid drug benefit, manufacturers provide rebates to the state and federal government. However, rebates are based on proprietary data and they are not available to the public at the drug level. As a result we are unable to include them, or use this data to calculate total Medicaid drug spending. After presenting this analysis, we place these findings in the context of policy discussions. Key findings of the analysis include:

  • Comprising 35% of prescriptions and 34% of spending before rebates in 2012, Central Nervous System Agents, a class of drugs that include pain killers, antidepressants, and antipsychotics, constitute the largest share of Medicaid drug utilization and spending. Within this drug class, pain killers and fever reducers represent a third of utilization.
  • Specialty drugs account for just two percent of drug utilization in 2012, but they comprise 28% of drug spending. This share increased from 2010 when they totaled 24% of drug spending before rebates. The specialty drug share of total drug spending varies at the state level.
  • Brand-name drugs account for a disproportionate amount of drug spending. In 2012, they accounted for 20% of Medicaid drug prescriptions but 76% of spending. In the past three years, the share of Medicaid drugs that are generic has risen slightly, possibly due to a number of blockbuster brand drugs losing their exclusivity and facing generic competition in the past several years.
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Complex temporal climate signals drive the emergence of human water-borne disease

December 19, 2014 Comments off

Complex temporal climate signals drive the emergence of human water-borne disease
Source: Emerging Microbes & Infections

Predominantly occurring in developing parts of the world, Buruli ulcer is a severely disabling mycobacterium infection which often leads to extensive necrosis of the skin. While the exact route of transmission remains uncertain, like many tropical diseases, associations with climate have been previously observed and could help identify the causative agent’s ecological niche. In this paper, links between changes in rainfall and outbreaks of Buruli ulcer in French Guiana, an ultraperipheral European territory in the northeast of South America, were identified using a combination of statistical tests based on singular spectrum analysis, empirical mode decomposition and cross-wavelet coherence analysis. From this, it was possible to postulate for the first time that outbreaks of Buruli ulcer can be triggered by combinations of rainfall patterns occurring on a long (i.e., several years) and short (i.e., seasonal) temporal scale, in addition to stochastic events driven by the El Niño-Southern Oscillation that may disrupt or interact with these patterns. Long-term forecasting of rainfall trends further suggests the possibility of an upcoming outbreak of Buruli ulcer in French Guiana.

See: Climate, emerging diseases: Dangerous connections found (Science Daily)

The Rise of the Medical Scribe: Industry Implications for the Advancement of Electronic Health Records

December 19, 2014 Comments off

The Rise of the Medical Scribe: Industry Implications for the Advancement of Electronic Health Records
Source: Journal of the American Medical Association

With federal meaningful-use incentives driving adoption of electronic health records (EHRs), physicians are increasingly concerned about the time spent documenting patient information and managing orders via computerized patient order entry (CPOE). Many perceive that the inefficiencies of EHRs are adversely affecting the quality of care, and because physicians see fewer patients per day, income may decline. Although physicians approve of EHRs in concept and appreciate their future promise, the current state of EHR technology has increased physician dissatisfaction. Poor EHR usability, time-consuming data entry, reduced patient care time, inability to exchange health information, and templated notes are central concerns. Physicians emphasize that EHR technology—especially user interfaces—must improve,1 and a new industry has emerged nationally to provide physicians with medical scribes.

Use of medical scribes—unlicensed individuals hired to enter information into the EHR under clinician supervision—has increased substantially. Scribes reportedly enable physicians to see more patients; generate more revenue; and improve productivity, efficiency, accuracy of clinical documentation and billing, and patient satisfaction.

New From the GAO

December 19, 2014 Comments off

New GAO Reports
Source: Government Accountability Office

1. Fair Labor Standards Act: Extending Protections to Home Care Workers. GAO-15-12, December 17.
http://www.gao.gov/products/GAO-15-12
Highlights – http://www.gao.gov/assets/670/667603.pdf

2. Federal Emergency Management Agency: Opportunities Exist to Strengthen Oversight of Administrative Costs for Major Disasters. GAO-15-65, December 17.
http://www.gao.gov/products/GAO-15-65
Highlights – http://www.gao.gov/assets/670/667607.pdf

3. Department of Homeland Security: Continued Action Needed to Strengthen Management of Administratively Uncontrollable Overtime. GAO-15-95, December 17.
http://www.gao.gov/products/GAO-15-95
Highlights – http://www.gao.gov/assets/670/667618.pdf

4. Tax-Exempt Organizations: Better Compliance Indicators and Data, and More Collaboration with State Regulators Would Strengthen Oversight of Charitable Organizations. GAO-15-164, December 17.
http://www.gao.gov/products/GAO-15-164
Highlights – http://www.gao.gov/assets/670/667596.pdf

5.   State and Local Governments’ Fiscal Outlook: 2014 Update. GAO-15-224SP, December 17.
http://www.gao.gov/products/GAO-15-224SP
Podcast: http://www.gao.gov/multimedia/podcasts/667597

6.   Dodd-Frank Regulations: Regulators’ Analytical and Coordination Efforts. GAO-15-81, December 18.
http://www.gao.gov/products/GAO-15-81
Highlights – http://www.gao.gov/assets/670/667634.pdf

7.   Electronic Submissions in Federal Procurement: Implementation by the Army Corps of Engineers and Department of the Interior’s Bureau of Reclamation. GAO-15-253R, December 18.
http://www.gao.gov/products/GAO-15-253R

8.   Federal Food Safety Oversight: Additional Actions Needed to Improve Planning and Collaboration. GAO-15-180, December 18.
http://www.gao.gov/products/GAO-15-180
Highlights –  http://www.gao.gov/assets/670/667657.pdf

Value of connectivity: Facebook and Deloitte look at the economic and social benefits of expanding internet access

December 19, 2014 Comments off

Value of connectivity: Facebook and Deloitte look at the economic and social benefits of expanding internet access
Source: Deloitte and Facebook

Extending the opportunities that the internet can bring is critical to accelerating economic and social growth in developing economies, while enabling the transition from a resource-based to a knowledge-based economy.

Facebook has launched a global partnership, Internet.org, with the goal of making internet access available and affordable to all. They have commissioned Deloitte to examine the ways in which extending access can change economies and societies in developing countries and what benefits this would generate on a number of economic and social dimensions.

The findings suggest that if developing countries could bridge the gap in internet penetration to reach levels developed economies enjoy today, they would experience large increases in GDP growth and productivity and improvements in health conditions and education opportunities. This provides a clear potential to reduce poverty and promote long run economic and social development. The study finds that extending internet access in Africa, Latin America, India and South and East Asia to levels seen in developed countries today would deliver numerous benefits:

  • Long run productivity could be enhanced by as much as 25% in these developing economies.
  • The resulting economic activity could generate $2.2 trillion in additional GDP, a 72% increase in the GDP growth rate, and more than 140 million new jobs.
  • Personal incomes would increase by up to $600 per person a year, thus lifting 160 million people out of extreme poverty.
  • Evidence on the link between health literacy and mortality rates suggests that internet access could save 2.5 million people and 250,000 children.
  • 2.5 million HIV/AIDS patients could increase their life expectancy thanks to better monitoring and adherence to treatment.
    Another 640 million children may be able to access the internet and the wealth of information it makes available while they study.

National Trends in the Cost of Employer Health Insurance Coverage, 2003–2013

December 19, 2014 Comments off

National Trends in the Cost of Employer Health Insurance Coverage, 2003–2013
Source: Commonwealth Fund

Looking at trends in private employer-based health insurance from 2003 to 2013, this issue brief finds that premiums for family coverage increased 73 percent over the past decade—faster than median family income. Employees’ contributions to their premiums climbed by 93 percent over that time frame. At the same time, deductibles more than doubled in both large and small firms. Workers are thus paying more but getting less protective benefits. However, the study also finds that while premiums continued to rise through 2013, the rate of growth slowed between 2010 and 2013, following implementation of the Affordable Care Act. While families experienced slower growth in premium contributions and deductibles over this period, sluggish growth in median family income means families are paying more in premiums and deductibles as a share of their income than ever before.

The Uninsured: A Primer – Key Facts About Health Insurance and the Uninsured in America

December 19, 2014 Comments off

The Uninsured: A Primer – Key Facts About Health Insurance and the Uninsured in America
Source: Kaiser Family Foundation

Millions of people in the United States go without health insurance each year. Because nearly all of the elderly are insured by Medicare, most uninsured Americans are nonelderly (below age 65). A majority of the nonelderly receive their health insurance as a job benefit, but not everyone has access to or can afford this type of coverage. Together, Medicaid and the Children’s Health Insurance Program (CHIP) fill in gaps in the availability of coverage for millions of low-income people, in particular, children. However, Medicaid eligibility for adults remains limited in some states, and few people can afford to purchase coverage on their own without financial assistance.

The gaps in our health insurance system affect people of all ages, races and ethnicities, and income levels; however, those with the lowest incomes face the greatest risk of being uninsured. Being uninsured affects people’s access to needed medical care and their financial security. The access barriers facing uninsured people mean they are less likely to receive preventive care, are more likely to be hospitalized for conditions that could have been prevented, and are more likely to die in the hospital than those with insurance. The financial impact also can be severe. Uninsured families struggle financially to meet basic needs, and medical bills can quickly lead to medical debt.

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