The Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) have invited states to apply for participation in the Multi-payer Advanced Primary Care Practice Demonstration, an initiative in which Medicare will join Medicaid and private insurers in state-based efforts to improve the delivery of primary care and lower health care costs.

“Advanced Primary Care practices are one of our most promising models for improving the quality of care and bringing down health care costs across the country,” said HHS Secretary Kathleen Sebelius. “By having Medicare participate in these demonstration projects, for the first time ever, we’ll help these innovative models spread and take another big step towards building a health care system that works better for all Americans.”

An Advanced Primary Care (APC) practice, commonly referred to as the patient-centered medical home, is a leading model for efficient management and delivery of quality health care services. APC practices promote accessible, continuous, and coordinated family-centered care utilizing a team approach and emphasizing prevention, health information technology, care coordination and shared decision making among participating patients and their providers.

The demonstration is an opportunity to assess the effect of advanced primary care practice, when supported jointly by Medicare, Medicaid, and private health plans, on:

• The safety, effectiveness, timeliness, and efficiency of health care;
• Assuring access and appropriate utilization of services covered by Medicare, Medicaid, and private health plans, while lowering expenditures;
• The ability of beneficiaries to participate effectively in decisions concerning their care; and,
• The delivery of care consistent with evidence-based guidelines.

“This demonstration will mark the first time that Medicare, Medicaid and private insurers will join in a partnership with states to transform health care delivery,” said Marilyn Tavenner, acting CMS administrator and chief operating officer. “Enabling public and private providers to work together will provide a valuable opportunity to strengthen our health care system and improve the quality of care for people with Medicare, Medicaid, and private insurance. Improved efficiencies in the system could mean providers will be able to spend more time with their patients, provide higher quality care, and better coordinate that care with other medical professionals.”

To be eligible, states will need to demonstrate that they can meet certain requirements, including having a state agency responsible for implementing the program, being ready to make payments to participating practices six months after being selected for participation, and having mechanisms in place to connect patients to community-based resources.

CMS anticipates making awards to up to six states and will perform an independent evaluation of the projects conducted under this demonstration.

Demonstrations like the Multi-Payer Advanced Primary Care Practice allow CMS to test and validate innovative new models of health care delivery and to translate insights and lessons learned into future policy and program redesign. This demonstration is an example of the sort of programs that CMS will carry out under the Center for Medicare and Medicaid Innovation, which was authorized in the Affordable Care Act and will be in place no later than Jan. 1, 2011. The new center will allow CMS to significantly expand the portfolio of innovative demonstrations that will drive cost effectiveness and quality improvement in the health care system during the coming years.

Kids and teens often think they know what’s best. When it comes to preventing childhood obesity, maybe we should listen to them, says Baker Harrell, executive director of ACTIVE Life, a non-profit organization that seeks to combat obesity with social activism. Empowering kids to help families be healthier is more effective than lecturing our children on the importance of good nutrition, he says. Harrell and other experts recently spoke to BeSmartBeWell.com about the childhood obesity epidemic, its causes and solutions.

BSBW: How do we talk to today’s kids—the so-called ‘M generation’—about healthy choices?

Harrell: Young people in this generation seek out empowering experiences—experiences that allow their voice to be heard. For parents, what’s important is not talking down or telling a child to do something and instead becoming a collaborative partner with that young person. Let their voice be heard, let their perspective be heard and let their fears and desires be heard.

BSBW: How do we do that when it comes to food and nutrition?

Harrell: Look for opportunities to be active together as a family or to talk about food, and talk about healthy, nutritious food around the dinner table. But engage and then empower your children to become part of the family’s conversation. Admit to your child, ‘Hey, I need your help, our family needs your help and we need your voice. We need you to play a lead role in helping our family live a healthy, active lifestyle.’ That’s not something a young person hears very often.

Healthcare reform legislation has enacted changes that will significantly affect the Medicare Part D prescription drug program. The most immediate impact of the reform aims to close the “donut hole”, a component of the benefit design in which seniors must pay the full cost for their drugs themselves. However, while it will ultimately be phased out completely, the donut hole will continue to exist another ten years and will, in the meantime, be more complex for beneficiaries than in previous years. To address the new communication challenges this process creates, DestinationRx has launched its new Medicare Drug Compare (MDC) tool, aimed at helping seniors better understand annual prescription drug costs and making it easy to pinpoint the best and most affordable options based on specific needs.

The donut hole is a gap in coverage that occurs when spending by the beneficiary and the drug plan exceeds $2,830, at which point the member must pay the full cost of their medications. After they spend another $3,610, they become eligible for “catastrophic” drug coverage, under which they pay only 5% of their drug costs. The first step in the reform will offer a $250 rebate coupon for seniors entering this gap. Medicare Drug Compare will help seniors estimate their annual drug costs, including when they might fall into the donut hole, and offer ways to minimize or even avoid the donut hole by switching to lower cost alternative (LCA) drugs.

The MDC tool provides alternative choices to a user’s current prescription drugs, including generic drug options, which can be up to 80 percent cheaper, even when no direct generic drug is currently available. DestinationRx continually monitors the activity in the generic pharmaceutical marketplace to ensure the content is accurate and up to date. MDC takes the legwork out of researching drug choices and presents a comprehensive comparison that offers Medicare beneficiaries the potential for substantial savings on prescription drugs.

“Switching to lower cost drugs through our Medicare Drug Compare tool relieves the headache of prescription drug purchases for users while reducing overall spending for the carriers; it is a beneficial tool for all parties involved,” said Alexander Grunewald, Ph.D., Vice President of DestinationRx. “Lowering prescription drug costs for Medicare beneficiaries also reduces total drug spending for carriers. Furthermore, providing beneficiaries with access to the MDC tool improves member retention for providers because it enhances member satisfaction by simply helping users manage a complex and often expensive insurance plan.”

Medicare Drug Compare can be utilized by healthcare carriers through sophisticated integration of the tool onto their health plan’s website, making it directly available to their members. Both carriers and members reduce costs when beneficiaries improve formulary compliance with lower cost drugs. In addition, having access to lower cost drugs encourages seniors to actually buy and take their drugs, thus increasing adherence. These lower cost alternatives are provided through the same proprietary dose-specific mapping used by healthcare providers such as CMS and Medco.

The Medicare Drug Compare tool is user-friendly, taking seniors through screens where they can input their ZIP code, select their PDP or MAPD plan, and enter the drugs they are taking. For more specified results there is an option to select a pharmacy for network pricing or load a list of drugs using claims data. Users can see the monthly and annual savings of lower cost options in a clear and easy-to-read bar chart; they are encouraged to explore lower cost alternatives, and can quickly see the monthly and annual impact of switching to a lower cost drug. The MDC also offers a feature to request approval for a drug change from a physician, enabling users to immediately and easily act on the provided recommendations.

Many regions of the country are experiencing an unusually warm and wet spring – a weather pattern that is likely to foster an earlier and more severe mosquito season, the National Pest Management Association (NPMA) warns. The NPMA is asking homeowners to take action now to eliminate potential breeding sites for mosquitoes on or around their properties.

“The heavier-than-normal precipitation that many areas of the country received this spring have left areas of standing water, which are perfect mosquito breeding grounds,” says Missy Henriksen, vice president of public affairs for the NPMA. “This is cause for concern, as mosquitoes are not simply a nuisance pest but can spread dangerous diseases, notably West Nile virus (WNV), to humans.”

According to a report by the U.S. Centers for Disease Control and Prevention (CDC), there were 12,263 confirmed cases of WNV infection in the U.S. between 1999 and 2008 and 16,698 probable cases during that same time period. Symptoms of WNV infection include headache, fever, rash, muscle ache and gastrointestinal symptoms. WNV infection can lead to encephalitis and meningitis, but as many as 80% of infected humans show no symptoms at all.

NPMA offers these tips to protect homeowners from mosquitoes:

• Eliminate sources of stagnant water including birdbaths, “kiddie” pools, swimming pool covers, barrels, and other objects that collect water.
• Add a fountain or drip system to birdbaths and ponds on your property to keep water fresh.
• Keep windows and doors properly screened.
• Be alert when outdoors during dawn and dusk hours, when mosquito activity peaks.
• Avoid wearing loose-fitting clothing, open-toe shoes and sweet-smelling perfumes or colognes when outdoors.
• Plan ahead for spending time outdoors and wear mosquito repellant with DEET.
• If you have a mosquito infestation on your property, call a pest professional for additional advice and treatment.

Idaho Technology, Inc. has been awarded a contract by the U.S. Army Space and Missile Defense Command (USASMDC) to develop tests for multiple flu strains on the Joint Biological Agent Identification and Diagnostic System (JBAIDS). The JBAIDS instrument, already widely deployed across the globe, and the suite of flu tests that will result from this effort will be used to test military personnel and their families for Influenza A and B, and subtypes of A.

This latest initiative will replace the CDC Swine flu detection panel on JBAIDS for diagnostic detection of the 2009 novel influenza A (H1N1) that was granted by the Emergency Use Authorization by the FDA in August 2009.

Traditional flu testing can take more than 48-hours to diagnose using culture methods; the JBAIDS expanded influenza panel will provide results for six flu targets in less than an hour. This effort may lead to the development of additional infectious disease assays for JBAIDS.

“Testing for infectious disease such as the seasonal flu allows JBAIDS to move into the clinical diagnostics arena. This allows us to provide increased value beyond identifying biological warfare agents of concern to our troops,” said Todd Ritter, chief development officer of Idaho Technology.

A study led by Mayo Clinic suggests remission from Crohn’s disease may be more likely if patients get biologic therapy combined with immune-suppressing drugs first instead of immune-suppressing drugs alone. The study, published in the April 15, 2010 issue of the New England Journal of Medicine, found treatment of moderate to severe Crohn’s disease with infliximab plus azathioprine allows more patients to achieve remission and mucosal healing than therapy with azathioprine alone.

“These study results are strong enough to change clinical practice,” says William Sandborn, M.D., gastroenterologist and vice chair of the Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester. “They have certainly changed mine.”

The researchers in the international, multi-center SONIC (Study of Biologic and Immunomodulator Naive Patients in Crohn’s Disease) study recruited 508 patients with Crohn’s disease who were naive to immunomodulator drugs. The patients were then randomized to treatment: 169 infliximab monotherapy, 170 azathioprine monotherapy, or 169 infliximab plus azathioprine combination therapy. Patients underwent colonoscopies at baseline and again at week 26. Patients still in the trial at week 30 were given the option of continuing in a blinded extension trial for another 20 weeks.

Researchers found that 57 percent of patients who received combination therapy with infliximab and azathioprine achieved steroid-free remission after 26 weeks. This is compared to 44 percent of patients who achieved remission with infliximab monotherapy and 30 percent with azathioprine alone. Both the infliximab combination therapy and infliximab monotherapy groups were statistically superior to the azathioprine group. These results were durable through week 50 and overall results show comparable safety in the three groups.

Historically, patients with Crohn’s disease have been treated sequentially with steroids, then azathioprine, then monoclonal antibodies such as infliximab. The study definitively demonstrates that infliximab-based strategies are more effective than azathioprine, explains Dr. Sandborn.

“Results of this study will provide doctors and their patients with more information on how to use these drugs most appropriately to most effectively treat Crohn’s disease,” says Dr. Sandborn. “For the first time, we have longer term outcome data on the advantages of combination therapy that will help guide our treatment of patients with Crohn’s disease.”

Crohn’s disease is an inflammatory disorder of the gastrointestinal tract that affects an estimated 500,000 people in the United States. Symptoms include abdominal pain, fever, nausea, vomiting, weight loss and diarrhea. Crohn’s disease has no known medical cure. One common therapy used to manage the disease is a series of intravenous infusions of infliximab, which blocks tumor necrosis factor, an important cause of inflammation in Crohn’s disease. Azathioprine is an orally administered, small molecule immunosuppressive which has a broad immunosuppressive effect.

Each year, physicians at Mayo Clinic’s campuses in Arizona, Florida and Minnesota treat approximately 2,000 patients who have Crohn’s disease. For more information on the treatment of Crohn’s disease at Mayo Clinic click this link: http://www.mayoclinic.org/crohns/.

Mayo Clinic’s Division of Gastroenterology and Hepatology has been ranked #1 in U.S. News & World Report’s Honor Roll of Top Hospitals since the rankings began 20 years ago.

Dr. Sandborn provided consulting services for Centocor Ortho Biotech during the course of this research and received no personal compensation. Mayo Clinic received reimbursement for the services provided by Dr. Sandborn.

The payment per claim for prescription drugs used to treat injured workers in Florida was nearly 40 percent higher than in most study states, according to a new study by the Workers Compensation Research Institute (WCRI).

The 16-state study by the Cambridge, MA-based WCRI found that the average payment per claim for prescription drugs in Florida’s workers’ compensation system was $565—38 percent higher than the median of the study states.

The main reason for the higher prescription costs in Florida was that some physicians wrote prescriptions and dispensed the prescribed medications directly to their patients. When physicians dispensed prescription drugs, they often were paid much more than pharmacies for the same prescription.

The WCRI study, Prescription Benchmarks for Florida, found that some Florida physicians wrote prescriptions more often for certain drugs that were especially profitable. For example, Carisoprodol (Soma®, a muscle relaxant) was prescribed for 11 percent of the Florida injured workers with prescriptions, compared to 2 to 4 percent in most other study states.

Financial incentives may help explain more frequent prescription of the drug, as the study suggested. The price per pill paid to Florida physician dispensers for Carisoprodol was 4 times higher than if the same prescription was filled at pharmacies in the state.

The study reported that the average number of prescriptions per claim in Florida was 17 percent higher than in the median state. Similar results can be seen in the average number of pills per claim.

WCRI also noted that prices paid to Florida pharmacies were at the median of the 16 study states, due to Florida’s typical pharmacy fee schedule, which is set at the level of the Average Wholesale Price.

The WCRI study is the first in an annual series that benchmarks the cost, price and utilization of pharmaceuticals in workers’ compensation.

Workers Compensation Research Institute is a nonpartisan, not-for-profit membership organization conducting public policy research on workers’ compensation, healthcare and disability issues. Its members include employers, insurers, insurance regulators and state administrative agencies in the U.S., Canada, Australia and New Zealand as well as several state labor organizations.

To order this report, go to the WCRI web site: www.wcrinet.org.

A migraine is not your average headache. The pain of a migraine may feel dull, deep, intense or throbbing. That pain often sends migraine sufferers in search of a dark, quiet place to lie down. Untreated, migraines can last from four to 72 hours.

The April issue of Mayo Clinic Women’s HealthSource provides an overview of migraine prevalence, causes, triggers, treatments and prevention. Highlights include:

Prevalence: An estimated 30 million Americans cope with migraine. Women outnumber men by 2 or 3 to 1.

Causes: The cause of migraine isn’t fully understood, but both genetic and environmental factors play a role. Migraines often run in families.

Triggers: Many factors or events may trigger an attack, including stress; menstruation; use of oral contraceptives; changes in weather; going too long without eating; lack of sleep or too much sleep; bright lights, glare, loud noises or strong odors; alcohol; caffeine (too much or withdrawal); and certain foods (aged cheese, cured meats, chocolate, fried foods, others).

Medication: For mild to moderate migraine attacks, over-the-counter medications work well. They are most effective when taken as soon as symptoms begin. Options include aspirin, ibuprofen (Advil, Motrin, others), acetaminophen (Tylenol, others), naproxen sodium (Aleve, others), and combination pain relievers such as Excedrin Migraine. For severe headaches, several prescription medications are options, too.

Other treatment: Cognitive behavioral therapy, biofeedback training and relaxation techniques may make migraine medication more effective or reduce the need for it. Getting enough sleep, sticking with a regular schedule, eating regular meals, staying physically active, limiting alcohol and caffeine and managing stress also are important.

Prevention: Preventive treatment can reduce the headache burden by one-third to one-half or more. A doctor can discuss preventive medications that may be helpful, such as blood pressure medications, antidepressants and anti-seizure drugs. In addition, injections of botulinum toxin type A (Botox) into the scalp muscles can help prevent migraine. Injections need to be repeated every three months. The herbal products feverfew and butterbur may prevent migraine, through the benefits haven’t been proved. Supplements of coenzyme Q10 may also be useful for some people.

Migraine is a chronic condition. Episodes can occur anywhere from one or twice a year to once or twice a week. Symptoms can be controlled by working with a primary health care provider.

U.S. Department of Health and Human Services Secretary Kathleen Sebelius today announced awards to help states facilitate health information exchange and advance health information technology (health IT). Funded by the American Recovery and Reinvestment Act of 2009, today’s awards are part of the $2 billion effort to achieve widespread meaningful use of health IT and provide use of an electronic health record by every citizen by the year 2014. Every state and eligible territory has now been awarded funds under this program.

“These critical investments will help unleash the power of health information technology to cut costs, eliminate paperwork, and help doctors deliver high-quality, coordinated care to patients,” said Secretary Sebelius. “States are important partners in improving and expanding our electronic health records system. By improving the secure exchange of electronic health records between providers and hospitals within and across states, these awards mark a significant step in bringing our health system into the 21^st century.”

The health information exchange HIE awards announced today provide approximately $162 million to 16 states and qualified state designated entities (SDEs) to facilitate non-proprietary health information exchange that adheres to national standards. Health information exchange is critical to enabling care coordination and improving the quality and efficiency of health care.

“Today’s announcement of awards to 16 states and SDEs marks a significant milestone with all states now empowered to start their journey towards identifying innovative ways to break down theses barriers that prevent the seamless exchange of information, so that we can give patients the access to care they deserve and expect,” stated Dr. David Blumenthal, national coordinator for health information technology. “States play a critical leadership role in advancing the development of the exchange capacity of healthcare providers and hospitals within their states and across the nation. Health information exchange will enable eligible healthcare providers to be deemed meaningful users of health IT and receive incentive payments under the Medicare and Medicaid electronic health record (EHR) incentive program.”

These cooperative agreements were awarded under the authority of Title XIII of ARRA, the Health Information Technology for Economic and Clinical Health (HITECH) Act which amends Title XXX of the Public Health Service Act by adding Section 3013, State Grants to Promote Health Information Technology. Section 3013 provides for the awarding of competitive grants to promote health information technology. On February 12, 2010, HHS awarded $385 million to 40 states and SDEs. The awards announced today complete the awarding of cooperative agreements funded by this program.