The Healthcare Round-up: 2/7 -2/13

What’s better than a box of chocolates or a dozen fair trade, organic red roses?

A #healthpolicyvalentine. It’s cheaper too.

Wonks and journos quickly embraced the nerdy Twitter hash tag created last week by Health and Human Services staffer Emma Sandoe. Notable gems included:

1. Let’s grow Medicare-eligible together
2. I know I am being inpatient, but how about a private exchange?
3. I want to put the oh! in your ACO.
4. Roses are red, violets are blue. I could never ration my love for you.

Meantime, here are the notable gems in Real Endpoints’s healthcare round-up for the week of February 7-13:

Pfizer’s Lipitor Tactic Isn’t Working: At least in the coverage department at WellPoint. On February 9^th the insurer said that as of April 1, it will stop covering Pfizer’s Lipitor in preference for generic atorvastatin. The “no coverage” decision is one of the most visible signs yet of what payers will do to blunt the impact of discount or co-pay cards. (WellPoint had already decided in early December to make branded Lipitor a “tier 3”, non-preferred drug with generics sold by Watson and Ranbaxy given “tier 1” coverage.) Last fall as Lipitor lost its patent exclusivity, Pfizer announced a controversial program that provides the cholesterol-lowering medicine for $4, effectively diminishing payers’ attempts to steer patients to generics via tiering incentives. Instead of Lipitor costing $30-$50, a typical price for a Tier 3 medicine, the $4 co-pay card makes Lipitor cheaper than what many generics would cost the patient. But those cost-savings don’t extend to the payer, which is why some health plans like UnitedHealth and pharmacy benefits managers like Medco agreed to discount deals that maintain Lipitor’s preferred status in return for an undisclosed rebate. WellPoint’s new policy change won’t impact commercial clients that use an outside firm (like Medco) to handle their member’s drug benefits. Still the new rule “will apply to a large portion of our customer base,” WellPoint VP of clinical pharmacy services Colleen Haines told Dow Jones.

• See here for the Dow Jones/WSJ news coverage.

UnitedHealth’s Big Experiment On Quality of Care: Just days after WellPoint and Aetna announced they would reimburse primary care doctors more for delivering higher quality of care, UnitedHealth Group announced its own initiative. It’s the latest sign that payers are trying to upend traditional fee-for-service reimbursement with value-based contracts that shift more of the financial risk onto providers.  Unlike the WellPoint and Aetna efforts, United’s effort covers not just primary care providers, but specialists as well. That’s important, since much of the skyrocketing healthcare spend is tied to specialty products and procedures. Thus, as we noted in last week’s Round-up, ensuring specialists and hospitals are incented to find ways to work with primary care docs is critical to the cost-cutting cause.  According to a report by Bloomberg, the UnitedHealth program could cover as many as 70% of the insurer’s commercial members by 2015, making it much broader than Aetna or WellPoint’s efforts. And of course, this is all about cost-savings: according to Bloomberg, the payer estimates it will save two times the amount it spends on incentive payments for physicians thanks to a healthier membership and reduced hospitalization and other costs. United stands to gain not just in the claims administration department. Its service business Optum, which posted robust revenue growth in 2011, is perfectly situated to sell software, data, and even consulting services to providers interested in implementing value-based contracts.

• Read the WSJ coverage here.
• Here’s  Bloomberg’s take.
• Find UnitedHealth’s 4^th quarter earnings results here.
• Here’s the press release from Vanderbilt University

Defensive Orthopedic Medicine adds $2 billion to US healthcare costs: The internet (and typical hospital) is rife with jokes about orthopedists. What do you call two orthopods reading an EKG? A double blind study. But a report published in the February issue of the American Journal of Orthopedics is no laughing matter. Authored by a team of researchers at Vanderbilt University Medical Center, the study estimates US orthopedic surgeons annually order $2 billion worth of unnecessary medical tests – think X-rays, MRIs, or ultrasounds– due to their practice of defensive medicine. To gather the data, the Vanderbilt team surveyed 2000 randomly selected orthopedic surgeons about their practice habits; 1241 responded.  At least among this cohort of surgeons, approximately 30% of tests ordered were for defensive reasons, with the average doctor order over $8000 a month in unnecessary tests. With more than 20,000 practicing orthopedists in the US, the average cost associated with defensive scans quickly balloons to more than $2 billion. Payers are keen to crack down on the excess ordering of tests or procedures that help exonerate physicians from accusations of malpractice but don’t provide any significant additional benefit in care. Vanderbilt researcher and study author Alex Jahangir believes one solution to the problem is the creation of evidence-based guidelines that standardize orthopedic care. Certain payers like Aetna are testing the utility of evidence-based pathways in another high cost arena—cancer care.

Comparative effectiveness and rheumatoid arthritis: Two different scholarly articles this week address the issue of comparative effectiveness and rheumatoid arthritis. With the advent of multiple, pricey disease modifying agents, RA seems ripe for increasing payer oversight. Thus, a study published January 30 in the Annals of Rheumatic Disease is sure to capture eyeballs in the offices of pharmacy directors.  In the study, a team of researchers from the New York University Hospital for Joint Diseases compared the effectiveness of three different anti-TNFs – Humira, Enbrel, and Remicade—in naïve and “switched” RA patients. To measure clinical efficacy, the physicians monitored  more than 2000 patients to determine whether they achieved remission as well as other pre-defined response criteria at 6, 12, and 24 months.  They also measured whether patients persisted with a given therapy over time. The data suggest the drugs show equivalent efficacy in the parameters measured. Interestingly patients newly diagnosed with RA were more likely to stay on therapy when Remicade was prescribed; for all patients, response, remission and persistence outcomes fell if they were switched from one medicine to another.

The second study, published in the Archives of Internal Medicine, takes the biopharma industry to task, suggesting that even as the number of biologics to treat RA has grown, drug makers aren’t –surprise, surprise – conducting clinical trials that measure newer agents against existing standards-of-care. That’s precisely the same complaint made by most health technology assessment bodies in Europe. In this analysis, researchers from the Institut National de la Santé et de la Recherche Médicale in Paris combed through ClinicalTrials.gov, analyzing the protocols of all randomized controlled RA trials testing a biologic disease modifying drug between 2003 and 2009. During this period 91 trials were initiated and only 5 were structured as head-to-head trials. The authors conclude the other studies “are of questionable clinical interest because they avoid direct comparison between effective treatments and thus do not help practitioners choose the best treatment among all available for patients.” They also don’t help pharmacy directors establish coverage decisions based on important metrics like outcomes. (Hear, hear say the HTAs.)

• The abstract of the comparative effectiveness study can be found here.
• Click here to see the Archives of Internal Medicine Abstract and this link for a news story from Medscape.

Image courtesy of flickrer moonlightbulb via creative commons.