Managed care opportunities and approaches to supporting appropriate selection of treatment for sight preservation.

When evaluating the impact of vision-destroying diseases, pharmacologic therapies represent a significant cost to patients, insurance providers, and society. Currently, up to 11 million people in the United States have some form of age-related macular degeneration (AMD), which is one of the leading causes of vision loss in older Americans. Ophthalmologists have administered more than 6 million intravitreal injections of aflibercept, bevacizumab, pegaptanib, and ranibizumab last year.

The economic impact of peanut allergies.

The prevalence of peanut allergies, the most common food allergy in children, has tripled in the past 2 decades. Today, up to 2.5% of the pediatric population has been diagnosed with a peanut allergy.

Considerations for optimal management of patients with pulmonary arterial hypertension: a multi-stakeholder roundtable discussion.

A roundtable panel of national and regional managed care decision makers and providers met to discuss pulmonary arterial hypertension (PAH) and strategies for management. As a rare, complex disease with high economic costs and potentially devastating outcomes, PAH necessitates that managed care providers balance optimal care with efficient use of healthcare resources. PAH specialists are recognized by health plans as knowledgeable experts and integral partners in managing patients and resources.

Evolving strategies for the management of multiple myeloma: a managed care perspective.

Current challenges in the management of multiple myeloma (MM) include the changing treatment landscape and the need for better care coordination and improved communication. A roundtable meeting involving key stakeholders (physicians, nurses, pharmacists, managed care professionals, pharmaceutical industry professionals, and patient care advocates) was held to discuss challenges in the management of MM and evolving strategies to address these challenges and improve quality of care for patients with MM. Interventions discussed included the use of a treatment pathway to standardize treatment, decrease costs, and possibly increase efficacy by encouraging adherence to treatment guidelines whenever possible, and the use of an oncology medical home (OMH) to facilitate communication among treatment providers.

Advanced airway management simulation training in medical education: a systematic review and meta-analysis.

Objective: To perform a systematic review and meta-analysis of the literature on teaching airway management using technology-enhanced simulation.

Data Sources: We searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, and Scopus for eligible articles through May 11, 2011.

Study Selection: Observational or controlled trials instructing medical professionals in direct or fiberoptic intubation, surgical airway, and/or supraglottic airway using technology-enhanced simulation were included.

Looking at CER from the managed care organization perspective.

Background: The amount of available comparative effectiveness research (CER) is increasing, giving managed care organizations (MCOs) more information to use in decision making. However, MCOs may not be prepared to integrate this new and voluminous data into their current practices and policies.

Objectives: To describe ways that health care reform will affect MCO populations in the future, to examine examples of how MCOs have utilized CER data in the past, and to identify questions that MCOs will have to address as they integrate CER into future decision making.

Evaluation of health plan member use of an online prescription drug price comparison tool.

Background: Health plans have implemented tiered copayment systems to incentivize members to use less expensive medications. However, members need drug price information to make comparisons among therapeutic alternatives. Many health plans and pharmacy benefit management companies have implemented online prescription drug price comparison tools to provide such information.

Description of the outcomes of prior authorization of palivizumab for prevention of respiratory syncytial virus infection in a managed care organization.

Background: Respiratory syncytial virus (RSV) is the leading cause of upper and lower respiratory tract infections in infants and young children. Most children are exposed to the virus before they are 2 years old and experience such symptoms as cough, fever, and irritability. In a select population of infants, the virus can cause hypoxemia and hospitalization.

Humanistic, utilization, and cost outcomes associated with the use of botulinum toxin for treatment of refractory migraine headaches in a managed care organization.

Background: Few patients with migraine syndrome receive treatment with preventive medication regimens, and some of these patients fail to gain adequate migraine relief. Botulinum toxin has been suggested to be effective in the treatment of migraine for a select population. An integrated health system created a medical policy and a supporting preauthorization form that permits coverage of botulinum toxin for the off-label treatment of migraine for patients who (1) fail at least 3 drug classes for acute treatment, (2) fail at least 4 different preventive medication classes, and (3) receive consultation from a neurologist.

Pharmacy management of vaccines.

Background: Although standard vaccines have traditionally been granted full coverage in managed care, the recent introduction of several novel vaccine products has necessitated the revision of pharmacy management strategies throughout the nation.

Objective: To review pharmacy management strategies for a number of emerging vaccines, with unique plan perspectives from SelectHealth, an Intermountain Healthcare company serving approximately 500,000 members in Utah.

Summary: Because several recently introduced vaccines target previously unaddressed diseases and carry higher costs than traditional vaccines, several plans have adapted a novel approach to manage vaccine coverage on an individual product basis.

Effects of benefit design change across 5 disease states.

Objective: To assess the effects of benefit design change (BDC) on medication adherence and persistence (including switch in therapy), drug costs, and total healthcare costs.

Study Design: A retrospective study was performed using administrative claims data from an integrated healthcare system between January 2001 and December 2002.

Methods: Continuously enrolled patients in 2001 and 2002 with allergic rhinitis, asthma, diabetes mellitus, hypertension, or osteoarthritis belonged to employer groups with or without a pharmacy BDC as of January 1, 2002.

Utilization and drug cost outcomes of a step-therapy edit for generic antidepressants in an HMO in an integrated health system.

Objective: Antidepressants do not differ significantly in their ability to treat depression. Excluding the tricyclic antidepressants (TCAs), these drugs also do not differ significantly in their incidence of adverse events. Therefore, the initial choice of antidepressant medication should be based, in part, on cost.

Effects of a polypharmacy edit and reduced quantity limits on the utilization of triptans and overall costs in an integrated health system.

On January 1, 2004, Intermountain Healthcare Health Plans implemented a polypharmacy edit and reduced the quantity limits of triptans to minimize the risks associated with triptan polypharmacy. The intervention covered one oral triptan brand per month and allowed one alternate formulation, limited monthly oral triptan quantities, and recommended use of prophylactic medication. During 2003, the prescription count per quarter for triptans increased from 4,816 to 5,359.

Aligning patient care and asthma treatment guidelines.

This article describes how the National Asthma Education and Prevention Program Guidelines for the Diagnosis and Management of Asthma can be used in the clinical setting to improve a patient's everyday function and quality of life. Major recommendations are detailed and case studies provide a practical approach for patient management.

Best practices in innovative type 2 diabetes program management: a case study.

Objective: To illustrate, through a case study format, a successful type 2 diabetes disease management program.

Summary: Intermountain Health Care (IHC) has implemented an evidence-based, integrated approach to the management of type 2 diabetes that includes multiple interventions: (1) a regularly updated treatment algorithm; (2) a comprehensive data registry to rapidly identify patients with type 2 diabetes; (3) a system of regular patient reminders for laboratory and other relevant testing, such as eye and foot examinations; (4) patient education that fosters an understanding of the benefits of antidiabetic medications and the need for consistent treatment; (5) pharmacist and nurse involvement to facilitate physician appointments when needed, track medication use, ensure consistent compliance, and answer questions; and (6) physician performance reports that provide an opportunity for rapid peer-to-peer outcomes comparisons. The implementation of this program has yielded a substantial increase in the number of patients within the system identified with type 2 diabetes and an increase in the percentage of patients with improved glycemic control based on HbA1c, as well as an unexpected benefit--an increase in the number of patients with improved low-density lipoprotein cholesterol levels.

Development of a complementary and alternative medicine (CAM) pharmacy and therapeutics (P&T) subcommittee and CAM guide for providers.

Objective: The objective was 2-fold: (1) to evaluate the feasibility and value of developing a Pharmacy and Therapeutics (P&T) subcommittee aimed at scientifically evaluating complementary and alternative medicine (CAM) products for an integrated managed care organization (IMCO) and (2) to assess provider acceptance and usefulness of a CAM guide.

Methods: Three factors drove the decision to form a CAM P&T subcommittee to evaluate current commonly used CAM products: (1) physicians, pharmacists, and dieticians expressed a desire for an easy-to-use, scientifically based mechanism for evaluating the ever-increasing number of CAM products; (2) Intermountain Health Care Health Plans (Health Plans), the insurance division of this IMCO, offers access to certain CAM products to its members at a discounted price in an effort to remain competitive with other IMCOs; and (3) this IMCO owns and operates more than a dozen community pharmacies that sell CAM products. Some IMCO clinicians believed an efficacy and safety review of the products offered through the organization was warranted.

Assessing the need for a clinical COPD care program in a managed care organization.

Background: Chronic obstructive pulmonary disease (COPD), a systemic inflammatory condition, is costly and often devastating to patient quality of life. COPD is also greatly underdiagnosed and often inappropriately treated. A managed care organization therefore evaluated whether a systemwide COPD clinical program within its organization may be appropriate.