Journal of Managed Care Medicine, Genomics & Biotech
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Vol.12, No.4, 2009 Journal of Managed Care Medicine, Genomics & Biotech The Financial Implications of New Episodes of MDD Behavioral Health Update Hospital Contracting Trends The Management of Metabolic Health in the Workplace Genomics Biotech Institute The Relationship Between Rheumatoid Arthritis and Heart Failure Clinical Utility or Impossibility? Addressing the Molecular Diagnostics Health Technology Assessment and Reimbursement Conundrum Plus: Fall Managed Care Forum Looking for an Effective Health Promotion Program? Look No Further. You recognize the importance of promoting employee health, and Abbott does too. As a large employer and diversified health care company, we are deeply committed to helping people live healthier lives. This pursuit has guided our actions for more than a century. Let us join you now in working toward a future made better by wellness. For more information regarding Abbott’s health promotion program, Changes that Last a Lifetime®, please visit http://abbott.ctll.com JMCM Journal of JOURNAL Managed Care Medicine OF MANAGED CARE MEDICINE The Offi cial Journal of the NATIONAL ASSOCIATION OF MANAGED CARE PHYSICIANS 4435 Waterfront Drive, Suite 101 AMERICAN ASSOCIATION OF INTEGRATED HEALTHCARE DELIVERY SYSTEMS Glen Allen, VA 23060 (804) 527-1905 AMERICAN COLLEGE OF MANAGED CARE MEDICINE fax (804) 747-5316 AMERICAN ASSOCIATION OF MANAGED CARE NURSES EDITOR-IN-CHIEF A Peer-Reviewed Publication J. Ronald Hunt, MD Vol. 12, No. 4, 2009 PUBLISHER Jack F. Klose TABLE OF CONTENTS DIRECTOR OF COMMUNICATIONS The Financial Implications of New Episodes of MDD for Treatment Jeremy Williams Resistant Versus Stable Depressed Individuals C. Daniel Mullins, PhD, Brian Seal, PhD and Lisa Blatt, MA . 5 JOURNAL MANAGEMENT Douglas Murphy Preventative Behavioral Health Treatment: Stress and Medical Illness Communications Inc. 2613 North Parham Road, Suite B By Mark Rosenberg, MD, PHD . 14 Richmond, VA 23294 (804) 272-9100 Hospital Contracting Trends and Implications for Adoption and Use of fax (804) 272-1694 New Health Technologies MANAGING EDITOR Eric Faulkner, MPH, Josephine Mauskopf, PhD and Jay Bae, PhD . 16 Bill Edwards [email protected] The Management of Metabolic Health in the Workplace William Bunn, III, MD, JD, MPH, Joseph Leutzinger, PhD, Richard Nevins, MD, ART DIRECTOR Rick Gutierrez John Seibel, MD, FACP, MACE, and Sean Sullivan, JD . 25 ASSOCIATE EDITOR GENOMICS BIOTECH INSTITUTE Kari Jones The Relationship Between Rheumatoid Arthritis and Heart Failure Custom Article Reprints Geneva Briggs, PharmD . 35 High quality, custom article reprints of individual articles are available in print and Clinical Utility or Impossibility? Addressing the Molecular Diagnostics electronic formats. Contact The YGS Group, Health Technology Assessment and Reimbursement Conundrum 800-290-5460 or 717-399-1900, x100, Eric Faulkner, MPH . 42 FAX 717-399-8900. Email: journalofmanagedcaremedicine@ theygsgroup.com Fall Managed Care Forum Exhibitor/Sponsor Guide . 59 www.theygsgroup.com Journal of Managed Care Medicine Instructions for Authors The Journal of Managed Care is published by As- sociation Services Inc. Corporate and Circulation The Journal of Managed Care Medicine is a peer-reviewed national publication. Original articles offi ces: 4435 Waterfront Drive, Suite 101, Glen Al- dealing with the business or clinical side of managed care are welcome. Manuscript length gener- len, VA 23060; Tel (804) 527-1905; Fax (804) 747- 5316. 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No part of this publica- • Electronic version on CD or via e-mail in Microsoft Word tion may be reproduced or transmitted in any form or by any means, electronic or mechanical, • Bibliography/References, following the format of the AMA Manual of Style, 9th Ed. including photocopy, recording, or any informa- tion storage or retrieval system, without written • Brief biography of author(s) < 50 words and including academic/corporate affi liations consent from the publisher. The publisher does • Copyright transfer letter not guarantee, either expressly or by implication, the factual accuracy of the articles and descrip- tions herein, nor does the publisher guarantee the accuracy of any views or opinions offered by the For a complete copy of authors’ guidelines, authors of said articles or descriptions. contact JMCM’s Managing Editor, Bill Edwards, (804) 272-9100 (ext. 112). POSTMASTER: Send address changes to The Forward submissions to Journal of Managed Care Medicine Journal of Managed Care Medicine, 4435 Water- front Drive, Suite 101, Glen Allen, VA 23060. 2613 N. Parham Rd., Suite B • Richmond, VA 23294 www.namcp.org | Vol. 12, No. 4 | Journal of Managed Care Medicine 3 Editorial Review Board Michael Ackerman, MD, MBA Leo M. Hartz, MD, MHM Ronald Perrone, MD, MBA Senior Regional Medical Director VP Clinical Advocacy/Chief Medical Officer Chief Medical Officer United Health Care Blue Cross of Northeast PA MDNY Healthcare Alan Adler, MD, MS Barry K. Herman, MD, MMM Gary R. Proctor, MD Medical Director Senior Director, U.S. Medical Regional Chief Medical Officer, Federal Division Independence Blue Cross Medical & Research Specialist ValueOptions Inc. Pfizer Inc. Glen F. Auckerman, MD John W. Richards Jr., MD, MMM, CPE Medical Director Sharon Isikoff, MD, MBA, MPH President/CEO Nationwide Health Plans Medical Director Innovative Health Strategies PacifiCare of Arizona Robert Baker, MD, MMM, FAAP VP for Medical Affairs Thomas Kaye, RPh, MBA, FASHP Aran Ron, MD, MBA, MPH Unison Administrative Services Senior Pharmacy Director President and Chief Operating Officer Passport Health Plan Group Health Inc. Paul Barry, MD, MPH Medical Director, PrimeCare Andrei Klein, MD Mark R. Rosenberg, MD, PhD Novant Health Physician Advisor President/Medical Director Newark, Beth Israel Hospital Behavioral Health Management Madeleine Biondolillo, MD Corporate Medical Director Randall Krakauer, MD, MBA Jay Schechtman, MD, MBA Radius Management National Medical Director, Retiree Markets Senior VP, Chief Medical Officer Aetna Healthfirst Paul Bluestein, MD Chief Medical Officer Fernado C. Larach, MD, FACR, MBA Joseph Schwerha, MD, MPH Connecticare President Professor & Director of Occupational A-Bay Area Medical Clinics, PA Medicine Residency Anthony Bonagura, MD University of Pittsburgh Medical Director Catherine Marino, MD Aetna Inc. Chief Medical Officer MagnaCare Nancy Single, PhD Philip M. Bonaparte, MD VP, Mission Strategy and Alignment Chief Medical Officer American Cancer Society Jeff Martin, PharmD Horizon NJ Health Clinical Account Director Innoviant Inc. Robert H. Small, MD D. Kete Cockrell, MD Behavioral Health Medical Director Medical Director TriWest Healthcare Alliance Peter W. McCauley Sr., MD, CPE International Medical Group Medical Director Gottlieb/West Towns PHO Inc. Jacque J. Sokolov, MD Marshall Dawer, MD Chairman Medical Director SSB Solutions Great West Healthcare Wesley Mizutani, MD Talbert Medical Group Vera Dvorak, MD Scott Spradlin, DO, FACPF, ACOI Medical Director John M. Montgomery, MD VP Medical Affairs/Chief Medical Officer United Healthcare VP, Senior Care Solutions Group Health Plan Blue Cross Blue Shield of Florida Howard Garber, MD, MPH Bruce Steffens, MD Medical Director Lawrence Mullany, MD, MBA Market Medical Director Iowa–Central Illinois Johns Hopkins Health Care Medical Director United Healthcare AvMed Health Plans Mary Parish Gavinski, MD William D. Strampel, DO, FACOI Ray Mummery, MD, CMCE Chief Medical Officer Dean, Michigan State University Chief Medical Officer Community Care College of Osteopathic Medicine Dimension Health Uwe G. Goehlert, MD, MSC, MPH, MBA, FAAFP Prentiss Taylor Jr., MD Staff Physician Denis O’Connell, MD Regional Medical Center Director Northwestern Medical Center, Regional Medical Director Advocate Health Care Department of Emergency Medicine Blue Cross Blue Shield of NC Humberto Guerra-Garcia, MD A. Mark Parker, MD, MBA Pamella D. Thomas, MD, MPH, FACOEM Chief Medical Officer Medical Director Director, Wellness and Health Promotion CarePlus Health Plan Quality Assessment Systems Inc. Lockheed Martin Aeronautics 4 Journal of Managed Care Medicine | Vol. 12, No. 4 | www.namcp.org The Financial Implications of New Episodes of MDD for Treatment Resistant Versus Stable Depressed Individuals C. Daniel Mullins, PhD, Brian Seal, PhD and Lisa Blatt, MA Summary Objective: The primary aim of this study was to document the economic impact of increased direct medical costs associated with new treatment episodes of major depressive disorder (MDD). A second aim was to compare and contrast the mag- nitude of the cost drivers among MDD patients categorized as stable versus treat- ment resistant. Method: Administrative claims data from the PHARMetrics database on adults with new MDD treatment episodes were stratifi ed based upon