Jonathan Kantrowitz

A study sponsored by Medicaid Health Plans of America (MHPA) released today by The Lewin Group finds large-scale savings can be achieved if Connecticut and 12 other states abandoned their current pharmacy carve-out model in favor of a carve-in approach — including prescription drugs in health plans’ capitation payments. In “Projected Impacts of Adopting a Pharmacy Carve-In Approach Within Medicaid Capitation Programs,” Lewin researchers reported that these states where prescription drugs are not part of the Medicaid capitated rate but instead are “carved-out” – paid separately through the traditional fee-for-service (FFS) program – could collectively save $11.1 billion over 10 years through the carve-in model. These carve-out states are Connecticut, Delaware, Illinois, Iowa, Missouri, Nebraska, New York, Ohio, Tennessee, Texas, Utah, West Virginia and Wisconsin.

Study highlights show how health plans’ pharmacy carve-in approach saves state Medicaid dollars versus traditional FFS:
- Health plans pay pharmacies lower dispensing fees – FFS programs usually pay considerably more for pharmacists to fill prescriptions than health plans pay.
- Health plans pay pharmacies lower ingredient costs – FFS programs appear to pay slightly more for the actual cost of the medications.
- Health plans encourage the use of generic medications – FFS programs don’t have the same capability to steer volume to lower-cost but clinically equivalent prescription drugs.
- Health plans have a lower medication use rate – FFS programs tend to prescribe more medications, in part because health plans more effectively identify unnecessary or fraudulent prescriptions.

After considering the above factors in their analysis, authors estimate total Medicaid savings across the 13 states would be over $11.1 billion over the next 10 years and $700 million in the first year alone. The study reports the potential savings for each of the 13 carve-out states, but notes that the extent of savings varies based on the size of their Medicaid capitation programs and the specific features of their FFS pharmacy programs.

“Given the severe budget crises many of these states are facing, the financial benefits of the pharmacy carve-in model are particularly important to access,” said Menges.
The study also noted that including a treatment option as important as prescription drugs in a Medicaid capitation program also contributes to the strength of the coordinated care model.
“Carving in prescription drugs will help the Medicaid health plans in these states more effectively treat disease in the coordinated care setting while maintaining the cost efficiency inherent in the capitated model,” stated Johnson.

The CT Rail Commuter Council has released its 2010 Annual Report highlighting the good news and bad in the previous year.

In the “bad news” department from last year the report highlights…

• Another delay in introduction into service of the new M8 rail cars
• No progress on increasing commuter parking at stations, many with 5 year waiting lists for annual parking permits
• No progress on replacing the Stamford garage set for demolition 6 years ago
• Delays in station repairs funded with federal stimulus money
• Continued complaints about poor communications with passengers during service disruptions

However, the Council is pleased to also report some “good news”…
• No fare increase in CT despite fare hikes and service cuts in NY State
• Continued improvement in on-time performance and increased ridership
• Signalization work started on the Danbury Branch
• New stations being built in Fairfield and West Haven

Health disparities are differences in health outcomes between groups that reflect social inequalities. Since the 1980s, our nation has made substantial progress in improving residents’ health and reducing health disparities, but ongoing racial/ethnic, economic, and other social disparities in health are both unacceptable and correctable. The Centers for Disease Control and Prevention has issued a new report CDC Health Disparities and Inequalities in the United States — 2011, outlining disparities in health among different populations in the US.

Some key findings of this report include:

• Lower income residents report fewer average healthy days. Residents of states with larger inequalities in reported number of healthy days also report fewer healthy days on average. The correlation between poor health and health inequality at the state level holds at all levels of income.

• Air pollution-related disparities associated with fine particulates and ozone are often determined by geographical location. Local sources of air pollution, often in urban counties, can impact the health of people who live or work near these sources. Both the poor and the wealthy in these counties can experience the negative health effects of air pollution; racial/ethnic minority groups, who are more likely to live in urban counties, continue to experience a disparately larger impact.

• Large disparities in infant mortality rates persist. Infants born to black women are 1.5 to 3 times more likely to die than infants born to women of other races/ethnicities.

• Men of all race/ethnicities are two to three times more likely to die in motor vehicle crashes than are women, and death rates are twice as high among American Indians/Alaska Natives.

• Men of all ages and race/ethnicities are approximately four times more likely to die by suicide than females. Though American Indians/Alaska Natives, who have a particularly high rate of suicide in adolescence and early adulthood, account for only about 1% of the total suicides, they share the highest rates with Non-Hispanic whites who in contrast account for nearly 5 of 6 suicides. The suicide rate among AI/ANs and non-Hispanic whites is more than twice that of blacks, Asian Pacific Islanders and Hispanics.

• Rates of drug-induced deaths increased between 2003 and 2007 among men and women of all race/ethnicities, with the exception of Hispanics, and rates are highest among non-Hispanic whites. Prescription drug abuse now kills more persons than illicit drugs, a reversal of the situation 15–20 years ago.

• Men are much more likely to die from coronary heart disease, and black men and women are much more likely to die of heart disease and stroke than their white counterparts. Coronary heart disease and stroke are not only leading causes of death in the United States, but also account for the largest proportion of inequality in life expectancy between whites and blacks, despite the existence of low-cost, highly effective preventive treatment.

• Rates of preventable hospitalizations increase as incomes decrease. Data from the Agency for Healthcare Research and Quality indicate that eliminating these disparities would prevent approximately 1 million hospitalizations and save $6.7 billion in health-care costs each year. There also are large racial/ethnic disparities in preventable hospitalizations, with blacks experiencing a rate more than double that of whites.

• Racial/ethnic minorities, with the exception of Asians/Pacific Islanders, experience disproportionately higher rates of new human immunodeficiency virus diagnoses than whites, as do men who have sex with men (MSM). Disparities continue to widen as rates increase among black and American Indian/Alaska Native males, as well as MSM, even as rates hold steady or are decreasing in other groups.

• Hypertension is by far most prevalent among non-Hispanic blacks (42% vs 28.8% among whites), while levels of control are lowest for Mexican Americans. Although men and women have roughly equivalent hypertension prevalence, women are significantly more likely to have the condition controlled. Uninsured persons are only about half as likely to have hypertension under control than those with insurance, regardless of type.

• Rates of adolescent pregnancy and childbirth have been falling or holding steady for all racial/ethnic minorities in all age groups. However, disparities persist as birth rates for Hispanics and non-Hispanic blacks are 3 and 2.5 times those of whites, respectively.

• More than half of alcohol consumption by adults in the United States is in the form of binge drinking (consuming four or more alcoholic drinks on one or more occasion for women and five or more for men). Younger people and men are more likely to binge drink and consume more alcohol than older people and women. The prevalence of binge drinking is higher in groups with higher incomes and higher educational levels, although people who binge drink and have lower incomes and less educational attainment levels binge drink more frequently and, when they do binge drink, drink more heavily. American Indian/Native Americans report more binge drinking episodes per month and higher alcohol consumption per episode than other groups.

• Tobacco use is the leading cause of preventable illness and death in the United States. Despite overall declines in cigarette smoking, disparities in smoking rates persist among certain racial/ethnic minority groups, particularly among American Indians/Alaska Natives. Smoking rates decline significantly with increasing income and educational attainment.

Differences in health based on race, ethnicity, or economics can be reduced, but will require public awareness and understanding of which groups are most vulnerable, which disparities are most correctable through available interventions, and whether disparities are being resolved over time. These problems must be addressed with intervention strategies related to both health and social programs, and more broadly, access to economic, educational, employment, and housing opportunities. The combined effects of programs universally available to everyone and programs targeted to communities with special needs are essential to reduce disparities

The bodies of virtually all U.S. pregnant women carry multiple chemicals, including some banned since the 1970s and others used in common products such as non-stick cookware, processed foods and personal care products, according to a new study from UCSF. The study marks the first time that the number of chemicals to which pregnant women are exposed has been counted.

Analyzing data for 163 chemicals, researchers detected polychlorinated biphenyls (PCBs), organochlorine pesticides, perfluorinated compounds (PFCs), phenols, polybrominated diphenyl ethers (PBDEs), phthalates, polycyclic aromatic hydrocarbons (PAHs) and perchlorate in 99 to 100 percent of pregnant women. Among the chemicals found in the study group were PBDEs, compounds used as flame retardants now banned in many states including California, and dichlorodiphenyltrichloroethane ( DDT), an organochlorine pesticide banned in the United States in 1972.

Bisphenol A (BPA), which makes plastic hard and clear, and is found in epoxy resins that are used to line the inside of metal food and beverage cans, was identified in 96 percent of the women surveyed. Prenatal exposure to BPA has been linked to adverse health outcomes, affecting brain development and increasing susceptibility to cancer later in life, according to the researchers.

Findings will be published in Environmental Health Perspectives on Jan. 14.

The study was not designed to identify direct connections to adverse health outcomes.

“It was surprising and concerning to find so many chemicals in pregnant women without fully knowing the implications for pregnancy,” said lead author Tracey Woodruff, PhD, MPH, director of the UCSF Program on Reproductive Health and the Environment.

“Several of these chemicals in pregnant women were at the same concentrations that have been associated with negative effects in children from other studies. In addition, exposure to multiple chemicals that can increase the risk of the same adverse health outcome can have a greater impact than exposure to just one chemical,” said Woodruff, an associate professor in the UCSF Department of Obstetrics and Gynecology and Reproductive Sciences.

Exposure to chemicals during fetal development has been shown to increase the risk of adverse health consequences, including preterm birth and birth defects, childhood morbidity, and adult disease and mortality according to the research team. In addition, chemicals can cross the placenta and enter the fetus, and in other studies, a number of chemicals measured in maternal urine and serum have been found in amniotic fluid, cord blood and meconium, they state.

The researchers analyzed data for 268 pregnant women from the National Health and Nutritional Examination Survey (NHANES) 2003-2004, a nationally representative sample of the U.S. population.

“Our findings indicate several courses of action. First, additional research is needed to identify dominant sources of exposure to chemicals and how they influence our health, especially in reproduction,” said Woodruff. “Second, while individuals can take actions in their everyday lives to protect themselves from toxins, significant, long-lasting change only will result from a systemic approach that includes proactive government policies.”

David Walker makes a lot of sense in some aspect of what he has to say (see my bold below) today’s Connecticut Post op ed:

The 112th Congress needs to pass fiscal 2011 and 2012 budgets that take a tough line on the base level of federal discretionary spending, including defense and homeland security… Yes, we need to engage in comprehensive tax reform and a new round of health-care reform..

But he cannot resist an opportunity to return to his old hobbyhorse, “reforming” Social Security:

Congress should move to reform Social Security to make it solvent, sustainable and more savings-oriented. It’s true that Social Security is a much smaller problem than Medicare and that, absent hitting the debt ceiling limit which could result in full Social Security benefits not being able to be paid on time, it does not face a near-term crisis as was the case in 1983.

However, Social Security is now adding to our annual federal deficits and is underfunded by almost $8 trillion. More importantly, Social Security represents the biggest opportunity to reform a social insurance program in a way that can exceed the expectations of every generation of Americans. It is an opportunity that we should not lose.

Perhaps he really means reform Social Security by raising the limit on incomes subject to the Social Security tax. After all, he denies that he favors cutting Social Security benefits. But I don’t believe that for a minute. Do you? That’s not what the common sense meaning of “reform Social Security” is. And that’s not what he was saying last year:

“There’s broad-based agreement as to the major elements of what’s needed for Social Security reform: to strengthen the benefit for people near the poverty level; to provide less replacement income for middle- and upper-income workers; to gradually increase the retirement eligibility ages in installments over time to encourage people to work longer and to index those ages to increases in life expectancy; to increase the taxable wage base cap.”

“to provide less replacement income for middle- and upper-income workers; to gradually increase the retirement eligibility ages in installments over time” – If that’s not reducing benefits, I don’t know what is.

If you are going to continue to push “Social Security reform” Mr. Walker, at least be honest and upfront as to what you mean.

P.S. His response to me the last time I called him on this, was “read my book.”

1. This is the wrong time of the year (NFL playoffs, UConn basketball, snow, cold, early darkness) to find this out:

Spending too much leisure time in front of a TV or computer screen appears to dramatically increase the risk for heart disease and premature death from any cause. People who devote more than four hours to screen-based entertainment like watching TV, using the computer or playing video games, are more than twice as likely to have a major cardiac event that involves hospitalization, death or both.

Question – why would working in front of a computer, or reading for work or leisure be any different? If not I’m in big trouble year round. I am going to try to get up and move around more while I work, watch sports, and read.

2. Or maybe I should lift weights while watching TV ( I actually tried to do this for a while):

Resistance Training Benefits Cardiovascular Health

3. Perhaps I should just sit (or move around) in the darkness all evening:

According to a recent study exposure to electrical light between dusk and bedtime strongly suppresses melatonin levels and may impact physiologic processes regulated by melatonin signaling, such as sleepiness, thermoregulation, blood pressure and glucose homeostasis.

4. I went and ate some blueberries as soon as I read this:

Eating blueberries can guard against high blood pressure

5. I don’t drink coffee, but probably should, but do drink a lot of green tea:

Coffee protects against diabetes

Regularly drinking green tea could protect against Alzheimer’s and other forms of dementia

Nothing else new here, but it’s a great summary:

Research indicates that tea strengthens the body’s immune system, reduces buildup of plaque on arterial walls, and aids in the control and prevention of diabetes.

Like tea, coffee is packed with polyphenols, and it actually has a higher content of antioxidants than green or black tea and other beverages such as fruit and vegetables juices. New research has suggested that coffee consumption can lower cardiovascular risks as well as lower the risk of developing type 2 diabetes by up to 50 percent. Coffee also appears to have a positive effect on neurological diseases with coffee consumption possibly reducing the risk of both Parkinson’s disease and Alzheimer’s disease.

6. I’m doing still not getting quite enough red wine ( and an occasional beer) but I’m doing better, and I take a resveratrol pill as well:

a. Alcohol Abstinence = Increased Risk of Cognitive Impairment

Both abstainers and subjects consuming large amounts of alcohol have a greater risk for cognitive impairment than light drinkers.

b. How resveratrol works

7. I’ve been repeatedly urged to get this shot by my pediatrician ( my daughter). I don’t find the evidence all that overwhelming:

Shingles Vaccine Associated With 55 Percent Reduced Risk of Disease

8. And, of course more research on diet, (I’m doing much better choosing the right kinds of foods) exercise, ( I just joined a gym! -to get into shape for soccer) and Vitamin D. (I’m doing pretty well with supplements):

Diet

a. Mediterranean Diet Associated With Slower Rate of Cognitive Decline

New research suggests that eating a healthy diet rich in fruit and vegetables gives you a more healthy golden glow than the sun.

The face in the middle shows the woman’s natural colour. The face on the left shows the effect of sun tanning, while the face on the right shows the effect of eating more carotenoids. Participants thought the carotenoid colour looked healthier.

Exercise

a. Exercise Could Help Prevent, Treat Eating Disorders

b. Consistent exercise = lower risk of colon cancer death

Vitamin D

a. Low Vitamin D = Increased Risk of Hip Fracture

b. Vitamin D deficiency could be linked to the development and severity of certain autoimmune lung diseases.

I’ve talked to several well-educated Jewish friends who are unaware of what a blood libel is, or were until recently, so it’s not hard to understand that Sarah didn’t know what she was talking about.

So let’s pass on that – let’s assume that she just meant that it’s libel to suggest that the blood of the Arizona victims is on her hands. But is it? Is it libel to remind people that she put Giffords in her crosshairs, quite literally:

But it’s not just Palin. Even the head of Fox News has admitted that his guys have to tone down the rhetoric.

But some in the “sensible center” are insisting that “Both sides” need to tone down the rhetoric. Both sides? Where on the left have we called, the right-wing unAmerican, or fascist/ or trying to deprive us of our libertiies/ Where have we ( and by we, I mean nationally recognized spokespeople, not solitary bloggers or commenters on blog-sites) used violent analogies, or advocated violence itself (“2nd Amendment solutions”) ?

There’s just no comparison, and honest observers know it. The right has stepped over the line, and Sarah Palin’s response is both absurd and offensive, even if it’s ignorance driven.