CEPAC meeting – comparing treatment resistant depression treatments

Friday’s CEPAC meeting in Providence was fascinating. We spent the day comparing the clinical and cost effectiveness of some common and some new treatments for people with treatment resistant depression (TRD). Between 13 and 14 million Americans experience clinical depression each year, but only about half seek treatment and only 20% of those get adequate treatment. Unfortunately about half of those who get treatment do not respond to medications. One study found that medical and disability claims from employees with TRD are more than double the costs for other employees with depression. Options for these patients used to be limited but technology has advanced in recent years. CEPAC is a New England regional public advisory group convened to consider the clinical and cost effectiveness of competing treatments. CEPAC includes clinicians, academics, patient advocates and (nonvoting) payer representatives. Friday’s discussion centered on Repetitive Transcranial Magnetic Stimulation, a new, slightly more expensive alternative to Electroconvulsive Therapy, which has been in use for over 70 years. There are some small studies with promising results suggesting rTMS may work better for some patients with fewer side effects. We discussed the impact on subpopulations, underserved populations, Medicaid and private payers, clinicians and, most importantly, patients and their families desperate for help. We reviewed evidence that everyone agreed was inadequate and conflicting. There are almost no studies that measured long term effectiveness. And then we voted.

Upcoming webinars on overtreatment and shared decisionmaking

Join us for two upcoming webinars on similar themes.

The first will be December 28th at 10am with Rosemary Gibson, author of The Treatment Trap. Rosemary will describe the Overuse of Medical Care and what can be Done to Prevent It. To register, go to https://www1.gotomeeting.com/register/828589337.

The second is the Promise of Shared Decision-Making – Engaging Patients and Improving Care, Jan. 10th at 1pm. Hear Shannon Brownlee, author of Overtreated, and Ben Moulton, from the Foundation for Informed Medical Decision-making, talk about how policymakers can help inform patients about all their options and avoid unnecessary treatment. To register, go to https://www1.gotomeeting.com/register/968183345

New blog – CT Health Insurance Exchange Watch

A new blog, CT Health Insurance Exchange Watch, is tracking development of CT’s Health Insurance Exchange. The blog is jointly sponsored by Small Business for a Healthy CT and the CT Health Policy Project. The latest entry includes an analysis noting that the percent of small businesses in MA offering health benefits to workers rose by 2% from 2005 to 2010, while the US average fell 4% and CT’s rate dropped 7%. MA implemented sweeping health reforms in 2006, including creation of a health insurance exchange. Members of CT’s exchange Board have been hyper-focused on low small business enrollment in MA’s exchange, but they are asking the wrong question. If offer rates are up, who cares if they are buying their coverage in the exchange or outside it? If building a source of affordable, quality health care puts pressure on the rest of the market, it has done its job. CT’s Board needs to focus on building a functional exchange that exerts competitive pressure on the entire market to expand coverage options with value.
Ellen Andrews

45% of CT individual health plans last year would not have triggered consumer rebates under new federal rules

A Hartford Courant analysis of 2010 individual health plans sold in CT finds that 45% did not spend at least 80% of premiums on members’ medical expenses. A rule requiring plans to meet that standard, termed medical loss ratio, did not take effect until this year. Plans that don’t reach that standard, overspending on administration and profit, will have to refund the difference to individuals. If the rule had been in place last year, 48,300 CT residents would have received refunds. Up to 9 million Americans could be eligible for rebates averaging $164, totaling $1.4 billion according to HHS. While almost half of CT individual plans would not have achieved the new standards last year, almost all small groups plans would have comfortably met the standard.
Ellen Andrews

New slides posted to cthealthbook.org

Updated slides from a health policy undergraduate class are available online at cthealthbook.org. Class topics include CT’s health care system, health care finance, international comparisons, Medicare, Medicaid, food policy and health, drugs, long term care, and national health reform, among others.

Small businesses ask HHS for help with CT insurance exchange

Small Business for a Healthy CT, a coalition of small companies, sent a letter yesterday asking HHS Secretary Sebelius to intervene with CT policymakers and reverse insurance industry domination of the CT Health Insurance Exchange Board. SBHCT is among at least a dozen advocacy groups that have voiced concerns about the Board membership which includes three insurance industry representatives but no voting consumer representatives and only one small business owner. The exchange is being created under national health reform with federal funding and is meant to be a consumer-friendly marketplace for coverage. It is expected that one in ten CT residents will get their coverage through the exchange. State law excludes anyone “affiliated” with insurance companies from Board membership and federal regulations state that consumer representatives should be a majority of voting members. The Board will decide which insurance plans are allowed to offer plans in the exchange, what benefits they have to offer, what standards they have to meet and how much they can charge consumers. Press reports include radio reports, CT News Junkie, the New Haven Register, Hartford Business Journal, Public News Service, CT Mirror, and The Hill.
Ellen Andrews

Yalies invent 3D imaging system for skin lesions

Three Yale undergraduate students have developed the 3Derm System, a small imaging device to transmit 3 dimensional images of potential skin lesions. The device allows patients to take an image of a questionable lesion at home and send it to a dermatologist, who can assess it. It will allow doctors to monitor changes in a lesion over time. The 3D image allows doctors, wearing special glasses, to assess the texture of a lesion. They hope to be able to reduce unnecessary doctor appointments by 40%. The students have won over $100,000 in prizes in two competitions for the device. They hope to eventually sell the 3Derm System in drug stores for under $100.
Ellen Andrews