A path to improve colorectal cancer screening outcomes: faculty roundtable evaluation of cost-effectiveness and utility.

The American Journal of Managed Care® and Exact Sciences Corporation hosted a roundtable meeting to discuss the impact of colorectal cancer (CRC) screening modalities on improving patient outcomes. The roundtable participants were a diverse panel of experts, including primary care, gastroenterology, and oncology providers; experts in health outcomes research and health policy; and managed care executives with commercial and public payer experience. Participants discussed CRC prevention and treatment strategies, screening modalities and adherence, molecular diagnostics, patient navigation, evaluation of large data sets, managed care, outcomes research, quality improvement, and reimbursement policies.

Value-Based Benefit Design to Improve Medication Adherence for Employees with Anxiety or Depression.

Background: Through reduced out-of-pocket costs and wellness offerings, value-based benefit design (VBBD) is a promising strategy to improve medication adherence and other health-related outcomes across populations. There is limited evidence, however, of the effectiveness of these policy-level changes among individuals with anxiety or depression.

Objectives: To assess the impact of a multifaceted VBBD policy that incorporates waived copayments, wellness offerings, and on-site services on medication adherence among plan members with anxiety or depression, and to explore how this intervention and its resulting improved adherence affects other health-related outcomes.

Impact of Employer-Sponsored Onsite Pharmacy and Condition Management Programs on Medication Adherence.

Background: Poor medication adherence is associated with worsened health outcomes and higher health care expenditures. An increasing number of employers are sponsoring wellness initiatives designed to support healthy lifestyles, improve productivity, and offer a return on investment. Onsite pharmacies may facilitate higher medication adherence rates by providing employees a convenient, low-cost option for filling prescriptions that is integrated with other onsite health services.

Impact of chiropractic services at an on-site health center.

Objective: To compare the influence of employer-sponsored, on-site chiropractic care against community-obtained care on health care utilization.

Methods: This was a retrospective claims analysis of members of a single employee health plan receiving chiropractic care on-site or off-site from 2010 to 2012. Utilization differences were evaluated by having 1 health care event or more, including radiology or clinical visits.

Implementation of a pharmacy-based adult vaccine benefit: recommendations for a commercial health plan benefit.

Background: Although vaccination rates in children exceed 90% in the United States, adults are vaccinated at far lower rates. In order to address this issue, additional community immunizers are needed, and pharmacists are in an ideal position to fill this void.

Objectives: To explore issues and barriers related to implementation of a pharmacy-based adult vaccine benefit and develop recommendations supporting a pathway for benefit expansion.

The spectral properties of (-)-epigallocatechin 3-O-gallate (EGCG) fluorescence in different solvents: dependence on solvent polarity.

(-)-Epigallocatechin 3-O-gallate (EGCG) a molecule found in green tea and known for a plethora of bioactive properties is an inhibitor of heat shock protein 90 (HSP90), a protein of interest as a target for cancer and neuroprotection. Determination of the spectral properties of EGCG fluorescence in environments similar to those of binding sites found in proteins provides an important tool to directly study protein-EGCG interactions. The goal of this study is to examine the spectral properties of EGCG fluorescence in an aqueous buffer (AB) at pH=7.

Is there an association between elevated or low serum levels of phosphorus, parathyroid hormone, and calcium and mortality in patients with end stage renal disease? A meta-analysis.

Background: Biochemical markers of altered mineral metabolism have been associated with increased mortality in end stage renal disease patients. Several studies have demonstrated non-linear (U-shaped or J-shaped) associations between these minerals and mortality, though many researchers have assumed linear relationships in their statistical modeling. This analysis synthesizes the non-linear relationships across studies.

Systematic review of employer-sponsored wellness strategies and their economic and health-related outcomes.

This review determines the characteristics and health-related and economic outcomes of employer-sponsored wellness programs and identifies possible reasons for their success. PubMed, ABI/Inform, and Business Source Premier databases, and Corporate Wellness Magazine were searched. English-language articles published from 2005 to 2011 that reported characteristics of employer-sponsored wellness programs and their impact on health-related and economic outcomes among US employees were accepted.

Value of chiropractic services at an on-site health center.

Objective: Chiropractic care offered at an on-site health center could reduce the economic and clinical burden of musculoskeletal conditions.

Methods: A retrospective claims analysis and clinical evaluation were performed to assess the influence of on-site chiropractic services on health care utilization and outcomes.

Results: Patients treated off-site were significantly more likely to have physical therapy (P < 0.

Approaches to the management of agents used for the treatment of multiple sclerosis: consensus statements from a panel of U.S. managed care pharmacists and physicians.

Background: Multiple sclerosis (MS) is a chronic, disabling, and costly disease with several treatment options available; however, there is variability in evidence-based clinical guidelines. Therefore, payers are at a disadvantage when making management decisions without the benefit of definitive guidance from treatment guidelines.

Objective: To outline approaches for the management of agents used to treat MS, as determined from a group of U.

Managing the risks of on-site health centers.

This review sought to assess compliance concerns, determine risk management strategies, and identify opportunities for future research to contribute to employers' understanding of the laws and regulations that apply to on-site care. A comprehensive review of databases, professional organizations' websites, and journals resulted in 22 publications reporting on the consequences of noncompliance among on-site health centers accepted for inclusion. None of those studies reported a study design or quantifiable outcome data.

Cost-effectiveness of natalizumab versus fingolimod for the treatment of relapsing multiple sclerosis.

Background: With the addition of new agents for the treatment of multiple sclerosis (MS) (e.g., fingolimod), there is a need to evaluate the relative value of newer therapies in terms of cost and effectiveness, given healthcare resource constraints in the United States.

Systematic review of efficacy of dose-dense versus non-dose-dense chemotherapy in breast cancer, non-Hodgkin lymphoma, and non-small cell lung cancer.

Randomized controlled trials (RCTs) have suggested a potential advantage of dose-dense chemotherapy in improving disease-free and overall survival in patients with certain malignancies. This systematic review summarizes the literature on the efficacy of dose-dense chemotherapy across various cancers (breast cancer, non-Hodgkin lymphoma [NHL], and non-small cell lung cancer) and chemotherapy regimens. Among the 17 trials identified, few reported statistically significant differences between dose-dense and standard chemotherapy, and most were small with limited statistical power.

Systematic review and meta-analysis of real-world adherence to drug therapy for osteoporosis.

Objective: To quantify the adherence of patients to drug therapy for osteoporosis in real-world settings via a systematic review and meta-analysis of observational studies.

Methods: The PubMed and Cochrane databases were searched for English-language observational studies published from January 1, 1990, to February 15, 2006, that assessed patient adherence to drug therapy for osteoporosis using the following medical subject headings and keywords: drug therapy, medication adherence, medication persistence, medication possession ratio, patient compliance, and osteoporosis. Studies were stratified into 3 groups: persistence (how long a patient continues therapy), compliance (how correctly, in terms of dose and frequency, a patient takes the medication), and adherence (a combination of persistence and compliance).

Improving the management of chronic obstructive pulmonary disease.

As the fourth leading cause of death in the United States, chronic obstructive pulmonary disease (COPD) represents a major burden to the healthcare system and society at large. Underdiagnosis and undertreatment lead to an increased economic burden, with exacerbations being a key driver of costs. COPD symptoms compromise quality of life (QOL), which affects both patients and caregivers.