Medicare Part D-a roundtable discussion of current issues and trends.
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BACKGROUND: Medicare Part D was introduced with a goal of providing access to prescription drug coverage for all Medicare beneficiaries. Regulatory mandates and the changing landscape of health care require continued evaluation of the state of the Part D benefit. OBJECTIVE: To review the current state of plan offerings and highlight key issues regarding the administration of the Part D benefit. SUMMARY: The Part D drug benefit continues to evolve. The benefit value appears to be diluted compared to the benefit value of large employer plans. Regulatory restrictions mandated by the Centers for Medicare and Medicaid Services (CMS) are reported to inhibit the ability of plans to create an effective, competitive drug benefit for Medicare beneficiaries. Management in this restrictive environment impedes competitive price negotiations and formulary coverage issues continue to create confusion especially for patients with chronic diseases. The doughnut hole coverage gap represents a significant cost-shifting issue for beneficiaries that may impact medication adherence and persistence. To address these and other challenges, CMS is working to improve the quality of care for Part D beneficiaries by designing and supporting demonstration projects. Although these projects are in different stages, all stakeholders are hopeful that they will lead to the development of best practices by plans to help manage their beneficiaries more efficiently. CONCLUSIONS: A significant number of Medicare beneficiaries are currently receiving prescription drug benefits through Part D. The true value of this benefit has been called into question as a result of plan design parameters that lead to cost-shifting, an increasing burden for enrollees. Concerns regarding the ability to provide a competitive plan given the stringent rules and regulations have been voiced by plan administrators. In an effort to drive toward evidence-based solutions, CMS is working to improve the overall quality of care through numerous demonstration projects. (+info)
Hospital psychiatry for the twenty-first century.
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Prospective cost allocations for the chronic schizophrenic patient.
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Schizophrenia affects from 0.5 percent to 1.0 percent of the population and is often a chronic relapsing illness with high morbidity. Because it strikes young adults, the lifetime direct and indirect costs are considerable. One method of budgeting the costs of treatment is through a prospective method with the development of "risk-adjusted" capitation rates that take into account a patient's past use of services, perceived health status, and level of disability. Such a system may provide opportunities to improve the quality of mental health services by increasing service flexibility, particularly in the development and differentiation of outpatient services. The essence of the approach is to encourage early intervention by reducing financial barriers for patients, especially barriers to alternatives to expensive inpatient services. One method currently employed in Rochester, New York, which creates a capitation payment system for the chronically mentally ill, will be described. The implications of this system for public policy will be discussed as we struggle to treat and care for chronic schizophrenic patients in humane and compassionate ways. (+info)
Assessment issues and the cost of schizophrenia.
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A variety of factors must be considered in developing assessment procedures to evaluate the cost of schizophrenia. One is the definitional problem: definitions of schizophrenia have varied over time and space, with a tendency in recent years to narrow the concept substantially. These changes in definition, which reflect the increasing scientific rigor in psychiatry, make the task of establishing base rates, assessing morbidity and mortality, and ultimately determining the cost of schizophrenia more difficult. Efforts to assess the cost of schizophrenia must also take into account the fact that its cost is not simply monetary, nor can it be conceptualized using only the cost of treatment. The overall cost of schizophrenia also includes social and psychological costs experienced by patients and family members. The concept of "the overall cost" is discussed--the sum of costs to the patient (including suffering, loss of productivity, and mortality), the cost to the family (including suffering and loss of productivity), and cost of treatment (including medications, rehabilitation services, day hospitals, inpatient facilities, etc.). At present, standardized techniques are available only for assessing some aspects of patient costs, while assessments of family and treatment costs are relatively underdeveloped. Over the long run, reduction of the overall cost of schizophrenia is most likely to come from investment in research. The most effective way to reduce the overall cost is to develop improved treatments, to identify the pathophysiology and etiology of schizophrenia, and ultimately to identify ways to prevent it from occurring. (+info)
Measurement and reliability: statistical thinking considerations.
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Reliability is defined as the degree to which multiple assessments of a subject agree (reproducibility). There is increasing awareness among researchers that the two most appropriate measures of reliability are the intraclass correlation coefficient and kappa. However, unacceptable statistical measures of reliability such as chi-square, percent agreement, product moment correlation, as well as any measure of association and Yule's Y still appear in the literature. There are costs associated with improper measurements, unreliable diagnostic systems, inappropriate statistics and measures of reliability, and poor quality research. Costs are incurred when misleading information directs resources and talents into nonproductive avenues of research. The consequences of unreliable measurements and diagnosis are illustrated with some studies of schizophrenia. (+info)
The ethical implications of health sciences library economics.
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The intersection of ethics and economics is rarely discussed in the library literature or at conferences. This may be due, in part, to what economists describe as a romantic value system, that is, the belief that resources are or should be unlimited and available for exploitation by every individual with a need. But recent changes in the national economy for libraries are forcing a realization that individualistic codes of ethics and value systems do not always result in socially desirable consequences. The problems of information management and access cannot be solved by ethical individuals acting alone. Instead, a new consensus is needed on collective ethical behaviors to ensure that health information resources are managed for the common good. (+info)
How a new 'public plan' could affect hospitals' finances and private insurance premiums.
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