Thursday, March 13, 2008

Notes from the Avalere Conference, Part 2

More notes from the Avalere Diabetes / Broaden Your View Conference in Washington DC:

New number to remember: Just out.... diabetes mellitus cost the U.S. $172 billion in combined direct and indirect costs in 2007. Compared to 2002, that’s a greater than 30% increase.

Be of good cheer, the peoples’ business goes on: Diabetes, of all the chronic conditions, is a high-visibility opportunity for Congress to experiment with Medicare and Medicaid coverage. Starting in ’09, look for a flurry of diabetes-specific ‘cost and/or coverage and/or quality’ legislative proposals, including new types of reimbursement approaches (including ‘care coordination’), support for HIT (including electronic records and registries) and redefining the term ‘health care provider.’ Absent fundamental reform, expect a majority of this to be “demonstrations.” Depressed at the thought of even more demos? Me too and during an question and answer session I griped about that. I was reminded that demos have a good track record of helping to inform public policy and building consensus. What's more, sometimes you need a demo to prove something really works as well as its advocates think it works, "MHS being a case in point."

Patient education is necessary but not sufficient: A speaker asked 'how many of you know you should floss?’ Many hands went up in the conference room. ‘How many of you flossed this morning?’ Far fewer hands went up.

New acronym that makes you sound smart: GWAS aka ‘genome wide association studies’ are surveys of genetic variations in persons with an illness that compare those variations to persons without an illness. If the variation appears comparatively more frequently among persons with the disease, it can be used to not only predict the risk of future occurrence, it can point to an underlying cause. The disease causing genetic variations that are treated by drugs like metformin and TZDs have been identified, and other genetic variations that may ultimately be amenable to yet-to-be-developed drugs are in the chute. Thanks to GWAS, we ain’t seen nothing yet when it comes to diabetes treatment options.

In addition to ‘CER,’ see how many other acronyms and first names you recognize: Federally supported Comparative Effectiveness Research (CER) has attracted the support of AHIP, the BCBSA, MedPAC, CBO, IOM, Hillary, Barack and Gail. Everyone agrees that ‘evidence’ in health care is poorly defined and inconsistent. Think the answer is more gold standard randomized clinical trials? Too bad, because they are unaffordable, too time-consuming and utterly unrealistic. Let the games begin.

Got graphs? Check out this treasure box from the CDC for your next PowerPoint presentation

Do the math: Wal-Mart has come to realize that persons with Type 2 diabetes are an important market segment. Wal-Mart offers meters n’ strips, all kinds of food, $4 medications, eye centers, and walk-in clinics. It doesn’t hurt that all those persons with diabetes need to walk past other yellow-smiley consumer goods and, while they’re at it, may also decide to use the Wal-Mart pharmacy to also purchase their higher-margin non-generics.

Once a week exenatide (Byetta shot)? You heard it here first. Speaking of the incretins, they are associated with weight loss and less hypoglycemia. One speaker predicted that formulary placement of this class of drugs may ultimately be driven not only by patient demand, but by the threat of a suit over a preventable episode of hypoglycemia.

And now for a word from a ringside seat in Massachusetts’ health reform: Adults that are a) working, b) childless and c) young have been the greatest winners in this initiative; elders, children, their parents and the poor had coverage options all along. Worshipers at the Single Payor Shrine of the Left and Supplicants of the Free Market Goddess of the Right continue to loathe this program, but contrary to headlines in the Boston Globe and editorials in the Wall Street Journal, the center is holding. Yes, the budget has been exceeded, but that’s because a surprising number of persons have signed up. The insurance premiums themselves are turning out to be on target.

Dr. Google: Think it’s just EHRs, registries and decision support? Think again, because in any given day, more people go online for health care information than see a doctor. Yet, the information is still hard to find, understand and contextualize. Healthcare entities that combine the provider and the online information in a consumer friendly format is destined to win.

After hearing about continuous glucose monitors, the Disease Management Care Blog believes their coverage should be contingent on participation in an accredited disease management program. Ditto pumps. And what if an endocrinologist is involved? DM companies should get out of their way outsource the care and pay the endocrinologist (and their CDE) a majority of the disease management fee received for that patient.

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