Alternative Media: The Blog Roll - Pharmaceutical Executive

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Alternative Media: The Blog Roll
Matthew Holt deciphers the hype around disease management.

Pharmaceutical Executive


"This is the first real experience at putting disease management into the Medicare population."
How do you help people think logically about the future?" asks healthcare forecaster Matthew Holt. "First, you have to tell the truth about the present."

And that's what Holt tries to do. At his day job, he works as a consultant and editor of the FierceHealthcare newsletter. But after hours, Holt writes about a more three-dimensional truth on his site thehealthcareblog.com.

Holt says the blog gives his ego a microphone. But the several hundred readers that check out the blog daily, and who write in, say it puts daily developments in the context of the healthcare environment. Indeed, the blog offers readers a holistic perspective (mixed with a dollop of humor) unlikely to be found in newspapers—or boardrooms.

Here, Holt deciphers the hype around disease management (DM) and discusses how those programs will continue to evolve.

Why are DM programs growing so slowly? Holt: The savings DM programs offer are significant, but they are not absolutely enormous. You've seen, for example, cohort studies where one cohort gets the intervention and the other one doesn't. The savings compared to the control group are in the range of 15 percent, which is great, but it's not absolutely incredible. Then there were a couple of studies that came out fairly recently saying those programs produced no savings at all.

The point is DM programs are not going to save managed care companies 50 percent of their medical costs overnight for their most expensive patients. If that was the case, they would have done it a long time ago.

What is the size of the DM market? Based on a little bit of a back-of-the-envelope analysis I did, it's somewhere in the billion dollar range in terms of dollars paid out to DM companies and programs. That's growing, although future programs will be targeted to populations where savings are more easily attainable.

What DM programs are successful? Currently, DM programs are driven by telephone-based or call center-based programs—not online programs. It is not like thousands of congestive heart failure patients are entering their data onto the computer everyday. They are being bugged on the phone.

The programs that are growing relatively faster are tied to some kind of device. You have probably seen Health Hero Network's Health Buddy—a small survey device that attaches to a telephone and can communicate with other devices like scales. In that program, nurse intervention is reserved for exceptions rather than serving at the program's core. So they're more cost-efficient and probably more effective.

Why did Medicare bring more attention to disease management programs? Medicare has a bunch of demonstration projects going on called the Continuing Care Improvement Programs (CCIP) which were put into the Medicare Modernization Act (MMA) partly as a payoff to health plans and disease state management (DSM) companies, but more importantly to see if the DSM rhetoric can hold water when studied in a general Medicare population.

This is the first real experience at putting disease management into a general Medicare population, and among the 12 projects there'll be some 200,000 to 300,000 enrollees.

What are those programs' implications? Once you start putting people on DM programs and monitoring them versus a control population, it helps make pay-for-performance much easier—an area which Mark McClellan is very interested in. Because you now say, "What's working? What isn't?" So over the next few years, we'll see a lot more activity of that type around Medicare, both in the service program, but also in the now re-growing private sector Medicare Advantage Plans, which were basically subsidized to recruit more members in the MMA. They too are figuring out how to manage seniors using DSM.

How do electronic medical records (EMR) relate to disease management? As EMRs get introduced, they can help DSM companies and health plans figure out who is going to benefit from highly aggressive intervention—better than trying a shotgun approach with every disease category. Right now, EMR use is not widespread, but the development of disease registries is happening quite fast as more DSM programs are developed. Obviously, it's the patients who are candidates for DSM who appear in these registries. Health plans and providers are focusing first on trying to get those patients' records as complete as possible because it's among those populations that incomplete records (like retinal exams for diabetics, or out of range test results) can turn very expensive.

Why should pharma care about EMRs? You may have heard of a pill called Vioxx. People have been quibbling about the results of the various trials for a few years. But the first widespread confirmation really was the joint FDA-Kaiser analysis of Kaiser Permanente's records released in August 2004, linking together the long-term impact of particular types of drug use with outcomes, based on continuous EMR capturing of the data from large populations. I wish I'd figured out its importance in time to short Merck's stock! But in hindsight it was a seminal event.

Does industry supports EMRs? Pfizer has supported it through its investment with Microsoft and IBM in Amicore. But what's more interesting is the dichotomy within Big Pharma about whether or not they actually want EMRs to go forward. If you talk to Kim Slocum at AstraZeneca, he says yes, we need to record all the data we possibly can on the use of our products so we can show that they have a positive impact on health and costs. But Kim says there are plenty of people within pharma who don't share his views. After all, EMRs can answer some of the key questions that pharma has always turned away from, like: "Did this new pill improve health? Did it save money? Did it cost extra money?"

What type of pressure does this technology exert on pharma? Post COX-2s, Paxil (paroxetine) et al, the pharmaceutical industry will be forced to be far more open with the data it collects during clinical trials. But it's electronic medical records that will eventually deliver information about the real world use of prescription drugs. The spread of EMRs will happen on a timetable affected by payers, providers, and government, and although pharma could conceivably nudge it ahead, it's not a high priority for the industry.

As with every new technology, the most important thing for pharma executives to examine is when do electronic medical records go from being a curiosity to a mainstream method that researchers and governments use to assess the performance of medical interventions? At that point, pharma needs to be ready to answer the questions I've just raised rather than say, "We're running a clinical trial and will get back to you in two years, meanwhile keep taking the pills and trust in the FDA's approval from six years ago." Merck essentially brushed off the Kaiser Permanente study on Vioxx that way, but that defense will become less tenable as those data sets from years of EMR use build up.


Jim King
Launches Two interactive agencies, i-Frontier and Avenue A/Razorfish, both aQuantive operating units, are merging. The resulting firm will be known as Avenue A/Razorfish and represent a unified brand offering digital marketing services nationwide. Microsoft Network is partnering with publisher Rodale, the iVillage women's community site, medical encyclopedia Healthwise, and the HealthDay news service, to launch a specialized health site, MSN Health Fitness at http://health.msn.com. Content providers include the Mayo Clinic and Harvard Medical School.


Nancy Somerville
People John Glascott becomes senior vice-president, business development and sales for RealAge, joining Thomas O'Hara, recently named chief financial officer, and Chris D'Eon, appointed vice-president of marketing last month. Jim King joins Mindspan, an e-healthcare communications company, as vice-president of business development.


Riley McDonough
He was most recently vice-president of sales at Medical World Communications. Riley McDonough, formerly vice-president, advertising sales at ESPN.com was named senior vice-president, consumer markets at WebMD Health. Nancy Somerville has joined i.d.e.a.s., an integrated creative content studio in Orlando with clients that include the US Navy, Roche Molecular Diagnostics, and Walt Disney World, to lead its healthcare initiative as director, healthcare markets.

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