Archive for May 21st, 2009

Skin in the Game III

May 21st, 2009 | No Comments | Source: Reuters

merckAware of recent studies which showed that paying people to lose weight and quit smoking actually works, CIGNA and Merck have decided to launch a program that pays CIGNA beneficiaries to improve their diabetes control.

And if they happen to take Merck’s oral anti-diabetes medications during that effort, so much the better.

According to terms of the deal, CIGNA will review hemoglobin A1C results for enrollees who take oral hypoglycemic agents and if at the end of the year the values have improved, Merck will offer discounts on its entries in this field, Januvia and Janumet.

cignaCIGNA will also review claims data for people taking the 2 drugs to determine whether they’re using them as prescribed by their physicians.

If they are, Merck will increase its discounts to CIGNA for these drugs even more.

CIGNA would then supposedly pass the savings along to its beneficiaries. 

“Merck (is) the first major pharmaceutical company to offer discounts on its oral anti-diabetic products, supporting CIGNA’s efforts to reduce A1C levels for individuals with diabetes, regardless of what medication they may be taking,” said Eric Elliott, president of CIGNA Pharmacy Management.

Januvia was approved by the FDA in 2006. Janumet made the grade in 2007. Annual sales for the two are in the $1.5 billion range, and some experts predict that number will triple in the next few years making these drugs world leaders in the growing market for oral antidiabetic therapy.

Come to think of it, why wouldn’t Merck throw tuppence at a program that hooks patients on its high-end drugs for the rest of their lives?

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Pitt Provider Takes Case to Court

May 21st, 2009 | 1 Comment | Source: Pittsburgh Post-Gazette

West Penn Allegheny Health System claims it’s losing its shirt because its larger rival, the University of Pittsburgh Medical Center has colluded with Highmark, the area’s leading private insurer to drive it out of business.

saywhatSo it filed suit in federal court against both of ‘em.

West Penn’s accusations cite numerous activities since 2002 that ensured Highmark’s dominance while guaranteeing juicy payouts for UPMC.

“West Penn is running out of options,” Jan Jennings commented to the Pittsburgh Post Gazette. The CEO of American Healthcare Solutions added, “you don’t sue UPMC and Highmark, with the deep reserves of cash they both have, unless you’re desperate.”

UPMC released a statement saying it “unequivocally denies the allegations,” and that the filing is an attempt by West Penn Allegheny “to divert attention from (its) operating and financial difficulties.”

Last year, WPA took a $73 million write down caused by an overestimation of revenues derived from patient care. A month ago, the system reported operating losses of $9.1 million and a Q4 2008 net loss of $5.6 million.

Highmark officials announced they were “surprised and disappointed” by the lawsuit, while citing their recent$125 million loan to West Penn and multiple grants they provided to “strengthen (West Penn’s) administrative and information systems.”

West Penn claims the 2 organizations have “engaged in mutual back-scratching designed to preserve Highmark’s monopoly in health insurance and to permit UPMC to build a monopoly in sophisticated … health care in this region,” according to David McClenahan, its board chairman.

“I can’t judge the arguments. I just know these kinds of cases in general are very hard to prove,” Jennings opined.

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NSA: One Step Over the Line

May 21st, 2009 | No Comments | Source: NY Times

The National Security Agency has been intercepting email messages and phone calls of American citizens in violation of the already broad legal limits imposed by Congress last year, according to government intelligence officials.

yourgovernmentatworkThese officials indicate there has been significant and systemic, although possibly inadvertent “overcollection” of domestic communications involving people living in the US.

Last week the Justice Department acknowledged to the New York Times that, as part of a routine review of NSA operations, it “detected issues that raised concerns.”

Justice Department officials then “took comprehensive steps to correct the situation and bring the program into compliance” with the law and court orders, according to the statement.

The violations apparently began last July when Congress modified the law regarding government wiretapping powers on terrorism and spying suspects. The new spying framework apparently created implementation challenges and errors resulted.

The original law represented a triumph for the Bush administration, 3 years after his warrantless wiretapping program was outed in 2005.

After much wrangling in Congress, the original law permitted the NSA to collect, without court-approved warrants, gobs of international phone and email traffic as it passed across US telecom gateways, so long as the targets  were “reasonably believed” to be outside the US.

The modification was designed to assure the law wasn’t extended to US citizens but either something got lost in translation or NSA staffers ran into operational glitches making it difficult to distinguish domestic from international communications, or both.

sophisticatedNSAspytoolThe result was that the agency was targeting US citizens and domestic communications without warrants.

No one seems to know the scope of the problem, or if they do, no one’s talking.

It is not clear whether the NSA actively listened to conversations or read email from Americans, or whether it simply obtained access to them.

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