Patient-Reported Outcomes: You'll Get a Lot More Response if You Make It Fun To Do.

It may seem obvious, but people are more likely to remain engaged in an activity if they find it enjoyable-and outcomes back this up. Among the more than 1,000 patients who enrolled in our multiple sclerosis registry, 95% remained active after one year.

Oncology Care Model Headed for Shades of Gray.

Regardless of your politics, the motivation behind a program designed to curtail cancer costs is clear. Cancer epidemiology (the old are disproportionately affected), coupled with 21st century demography (longer life expectancy, aging boomers), means cancer costs are going up.

ADHD in managed care: an assessment of the burden of illness and proposed initiatives to improve outcomes.

Attention-deficit/hyperactivity disorder (ADHD) often results in persistent problems with attention and impulsivity; these problems, in turn, contribute to impairments in a wide range of functions that affect academic, social, and workplace performance. The chronic and cumulative effects of these difficulties can be overwhelming and outline the significant burden of illness associated with ADHD, which is realized in diminished quality of life for patients and their families and increasing costs or loss of revenue for payers and employers. This burden warrants significant consideration and action from managed care stakeholders to foster sound clinical practice and optimal care.

Multiple vaccines: how do we choose?

Background: As preventive medicine is a cornerstone of managed care, most health plans have traditionally featured automatic vaccine coverage routed through the medical benefit. However, with the advent of emerging vaccines, managed care stakeholders must revise decision-making processes and choose among multiple products targeting the same disease.

Objective: To review the motivating forces behind traditional vaccine coverage in managed care and discuss the need for managed care organizations (MCOs) to subject their vaccine policies to greater examination in the changing landscape of emerging vaccines.

Colorectal cancer: complexities and challenges in managed care.

Background: Managed care weighs advances and associated costs to determine whether the combination of longer life at sometimes significantly increased cost represents value. The price of treatment is only 1 factor.

Objective: To review treatment decision processes for oncologic agents in managed care environments.

Medication reconciliation: Harvard Pilgrim Health Care's approach to improving outpatient medication safety.

Hospitals and long-term care facilities have been addressing the issue of patient safety for some time. As a result of the increasing number of outpatient medication errors leading to adverse drug events (ADEs), interest in preventing outpatient medication errors has increased. Research indicates that the rate of outpatient ADEs may be about four times as high as that reported in hospital studies and that more than one third of these events are preventable (Gandhi et al.

Recommendations for best practices in the treatment of Alzheimer's disease in managed care.

Background: Alzheimer's disease and related dementias (ADRDs) are increasingly recognized as important causes of impaired cognition, function, and quality of life, as well as excess medical care utilization and costs in the elderly Medicare managed care population. Evidence-based clinical practice guidelines for ADRDs were published in 2001. More recent studies have resulted in the approval of new agents and demonstrated an expanded role for antidementia therapy in various types of dementia, settings of care, stages of disease, and the use of combination therapy.

Physician alerts to increase antidepressant adherence: fax or fiction?

Background: Many managed care organizations use feedback based on electronically maintained claims data to alert physicians to potential treatment problems, including patient medication nonadherence. However, the efficacy of such interventions for improving adherence among patients treated for depression is unknown.

Methods: We examined an antidepressant compliance program consisting of faxed alerts to physicians beginning May 2003 using interrupted time series analysis to evaluate its impact on rates of antidepressant adherence between May 2002 and May 2004 among members of the managed care plan of Harvard Pilgrim Health Care, which is a health plan operating in 3 states in New England, with corporate headquarters in Wellesley, Mass.

Analysis of the current care model of the COPD patient: a health outcomes assessment and economic evaluation.

Objective: Because chronic obstructive pulmonary disease (COPD) is a common but serious illness affecting millions worldwide, we present an overview of the disease and discuss its underdiagnosis and treatment options.

Summary: COPD, a disease encompassing emphysema and chronic bronchitis, is associated with cigarette smoking, chronic exposure to environmental pollutants, and, occasionally, genetic conditions. The disease is severely underdiagnosed and underrecognized.