Alicia Ault

If President Barack Obama sways Congress with his plans for health reform, hospitals and health providers would receive a bundled payment for care provided in the hospital and during the first 30 days after discharge.

The proposal was submitted as part of the president's budget “blueprint” in late February. A full budget plan is expected to be released some time this month. It's a long way from there to the proposal's becoming law; in some cases, proposals will require congressional action, while in others, they will be accomplished through federal rule making. Even so, this is not the first time that bundling has been mentioned as a cost-saving mechanism for federal health programs.

The Medicare Payment Assessment Commission (MedPAC) backed bundled payment in its June 2008 report to Congress, and the Centers for Medicare and Medicaid Services (CMS) began a 3-year, five-hospital demonstration project of the concept in January.

Along with bundling payments, the Obama budget also proposed paying less to hospitals with high readmission rates during the 30-day postacute period. The combination of bundling pay and reducing payments should save “roughly $26 billion of wasted money over 10 years,” according to the budget blueprint. That money would be contributed to the $600 billion reserve fund dedicated to financing health reform.

There were few other details offered by the administration. But in December, the Congressional Budget Office analyzed a proposal to bundle payments and estimated that it would create $950 million in savings from 2010 to 2014.

In a note to clients after the blueprint release, experts at Washington Analysis Corp. who follow health policy said, “We expect Congress to consider this idea, especially since this concept has been put forward for several years by CMS, MedPAC and others.”

Washington Analysis said that it also expected to see a proposal to penalize hospitals for high readmission rates.

If President Barack Obama sways Congress with his plans for health reform, hospitals and health providers would receive a bundled payment for care provided in the hospital and during the first 30 days after discharge.

The proposal was submitted as part of the president's budget “blueprint” in late February. A full budget plan is expected to be released some time this month. It's a long way from there to the proposal's becoming law; in some cases, proposals will require congressional action, while in others, they will be accomplished through federal rule making. Even so, this is not the first time that bundling has been mentioned as a cost-saving mechanism for federal health programs.

The Medicare Payment Assessment Commission (MedPAC) backed bundled payment in its June 2008 report to Congress, and the Centers for Medicare and Medicaid Services (CMS) began a 3-year, five-hospital demonstration project of the concept in January.

Along with bundling payments, the Obama budget also proposed paying less to hospitals with high readmission rates during the 30-day postacute period. The combination of bundling pay and reducing payments should save “roughly $26 billion of wasted money over 10 years,” according to the budget blueprint. That money would be contributed to the $600 billion reserve fund dedicated to financing health reform.

There were few other details offered by the administration. But in December, the Congressional Budget Office analyzed a proposal to bundle payments and estimated that it would create $950 million in savings from 2010 to 2014.

In a note to clients after the blueprint release, experts at Washington Analysis Corp. who follow health policy said, “We expect Congress to consider this idea, especially since this concept has been put forward for several years by CMS, MedPAC and others.”

Washington Analysis said that it also expected to see a proposal to penalize hospitals for high readmission rates.

If President Barack Obama sways Congress with his plans for health reform, hospitals and health providers would receive a bundled payment for care provided in the hospital and during the first 30 days after discharge.

The proposal was submitted as part of the president's budget “blueprint” in late February. A full budget plan is expected to be released some time this month. It's a long way from there to the proposal's becoming law; in some cases, proposals will require congressional action, while in others, they will be accomplished through federal rule making. Even so, this is not the first time that bundling has been mentioned as a cost-saving mechanism for federal health programs.

The Medicare Payment Assessment Commission (MedPAC) backed bundled payment in its June 2008 report to Congress, and the Centers for Medicare and Medicaid Services (CMS) began a 3-year, five-hospital demonstration project of the concept in January.

Along with bundling payments, the Obama budget also proposed paying less to hospitals with high readmission rates during the 30-day postacute period. The combination of bundling pay and reducing payments should save “roughly $26 billion of wasted money over 10 years,” according to the budget blueprint. That money would be contributed to the $600 billion reserve fund dedicated to financing health reform.

There were few other details offered by the administration. But in December, the Congressional Budget Office analyzed a proposal to bundle payments and estimated that it would create $950 million in savings from 2010 to 2014.

In a note to clients after the blueprint release, experts at Washington Analysis Corp. who follow health policy said, “We expect Congress to consider this idea, especially since this concept has been put forward for several years by CMS, MedPAC and others.”

Washington Analysis said that it also expected to see a proposal to penalize hospitals for high readmission rates.

In an eagerly anticipated opinion, the U.S. Supreme Court has upheld a lower court ruling that Food and Drug Administration approval does not give pharmaceutical companies immunity from product liability lawsuits.

The justices voted 6–3 to affirm the judgment of the Vermont Supreme Court that federal law did not preempt Diana Levine's claim of inadequate warning on the label of promethazine (Phenergan). Ms. Levine received the drug by intravenous push and subsequently lost her arm. She was awarded $6.7 million by a Vermont jury.

A majority of justices rejected the argument by Wyeth Pharmaceuticals Inc., maker of Phenergan, that it was impossible for the company to simultaneously comply with both federal and state laws and regulations.

Wyeth could have unilaterally strengthened the label at any time without input or clearance from the FDA, wrote the justices, concurring with the lower court opinion. And, the company's argument that following the duty to warn under state law would have interfered with the FDA's power to preempt state law was “meritless,” according to the majority opinion.

Justice Clarence Thomas voted with the majority, agreeing that Wyeth could have changed its label and complied with both state and federal laws. But he said that he did not agree with the majority's more far-reaching conclusions about preemption, specifically a tendency to override state laws when they were perceived to be an impediment to enforcing federal statutes.

Justice Samuel Alito and Justice Antonin Scalia, joined by Chief Justice John Roberts, dissented, writing in their opinion that “this case illustrates that tragic facts make bad law. The Court holds that a state tort jury, rather than the Food and Drug Administration, is responsible for regulating warning labels for prescription drugs.” That premise is not consistent with previous rulings, they wrote.

Indeed, just last year the U.S. Supreme Court ruled in Riegel v. Medtronic Inc., that FDA approval conferred special protection against product liability suits involving medical devices.

The Pharmaceutical Research and Manufacturers of America said that it was still reviewing the opinions in Wyeth v. Levine. “We continue to believe that the expert scientists and medical professionals at the FDA are in the best position to evaluate the voluminous information about a medicine's benefits and risks and to determine which safety information to include in the drug label,” PhRMA Senior Vice President Ken Johnson said in a statement.

Consumer advocacy group Public Citizen called the ruling a broad rebuff to the industry's attempt to duck tort damages. Brian Wolfman, director of Public Citizen Litigation Group, said that the organization was “extremely gratified” that the Court “upheld the traditional right of patients harmed by defective and mislabeled drugs to sue drug companies to recover compensation for their injuries.

In an eagerly anticipated opinion, the U.S. Supreme Court has upheld a lower court ruling that Food and Drug Administration approval does not give pharmaceutical companies immunity from product liability lawsuits.

The justices voted 6–3 to affirm the judgment of the Vermont Supreme Court that federal law did not preempt Diana Levine's claim of inadequate warning on the label of promethazine (Phenergan). Ms. Levine received the drug by intravenous push and subsequently lost her arm. She was awarded $6.7 million by a Vermont jury.

A majority of justices rejected the argument by Wyeth Pharmaceuticals Inc., maker of Phenergan, that it was impossible for the company to simultaneously comply with both federal and state laws and regulations.

Wyeth could have unilaterally strengthened the label at any time without input or clearance from the FDA, wrote the justices, concurring with the lower court opinion. And, the company's argument that following the duty to warn under state law would have interfered with the FDA's power to preempt state law was “meritless,” according to the majority opinion.

Justice Clarence Thomas voted with the majority, agreeing that Wyeth could have changed its label and complied with both state and federal laws. But he said that he did not agree with the majority's more far-reaching conclusions about preemption, specifically a tendency to override state laws when they were perceived to be an impediment to enforcing federal statutes.

Justice Samuel Alito and Justice Antonin Scalia, joined by Chief Justice John Roberts, dissented, writing in their opinion that “this case illustrates that tragic facts make bad law. The Court holds that a state tort jury, rather than the Food and Drug Administration, is responsible for regulating warning labels for prescription drugs.” That premise is not consistent with previous rulings, they wrote.

Indeed, just last year the U.S. Supreme Court ruled in Riegel v. Medtronic Inc., that FDA approval conferred special protection against product liability suits involving medical devices.

The Pharmaceutical Research and Manufacturers of America said that it was still reviewing the opinions in Wyeth v. Levine. “We continue to believe that the expert scientists and medical professionals at the FDA are in the best position to evaluate the voluminous information about a medicine's benefits and risks and to determine which safety information to include in the drug label,” PhRMA Senior Vice President Ken Johnson said in a statement.

Consumer advocacy group Public Citizen called the ruling a broad rebuff to the industry's attempt to duck tort damages. Brian Wolfman, director of Public Citizen Litigation Group, said that the organization was “extremely gratified” that the Court “upheld the traditional right of patients harmed by defective and mislabeled drugs to sue drug companies to recover compensation for their injuries.

In an eagerly anticipated opinion, the U.S. Supreme Court has upheld a lower court ruling that Food and Drug Administration approval does not give pharmaceutical companies immunity from product liability lawsuits.

The justices voted 6–3 to affirm the judgment of the Vermont Supreme Court that federal law did not preempt Diana Levine's claim of inadequate warning on the label of promethazine (Phenergan). Ms. Levine received the drug by intravenous push and subsequently lost her arm. She was awarded $6.7 million by a Vermont jury.

A majority of justices rejected the argument by Wyeth Pharmaceuticals Inc., maker of Phenergan, that it was impossible for the company to simultaneously comply with both federal and state laws and regulations.

Wyeth could have unilaterally strengthened the label at any time without input or clearance from the FDA, wrote the justices, concurring with the lower court opinion. And, the company's argument that following the duty to warn under state law would have interfered with the FDA's power to preempt state law was “meritless,” according to the majority opinion.

Justice Clarence Thomas voted with the majority, agreeing that Wyeth could have changed its label and complied with both state and federal laws. But he said that he did not agree with the majority's more far-reaching conclusions about preemption, specifically a tendency to override state laws when they were perceived to be an impediment to enforcing federal statutes.

Justice Samuel Alito and Justice Antonin Scalia, joined by Chief Justice John Roberts, dissented, writing in their opinion that “this case illustrates that tragic facts make bad law. The Court holds that a state tort jury, rather than the Food and Drug Administration, is responsible for regulating warning labels for prescription drugs.” That premise is not consistent with previous rulings, they wrote.

Indeed, just last year the U.S. Supreme Court ruled in Riegel v. Medtronic Inc., that FDA approval conferred special protection against product liability suits involving medical devices.

The Pharmaceutical Research and Manufacturers of America said that it was still reviewing the opinions in Wyeth v. Levine. “We continue to believe that the expert scientists and medical professionals at the FDA are in the best position to evaluate the voluminous information about a medicine's benefits and risks and to determine which safety information to include in the drug label,” PhRMA Senior Vice President Ken Johnson said in a statement.

Consumer advocacy group Public Citizen called the ruling a broad rebuff to the industry's attempt to duck tort damages. Brian Wolfman, director of Public Citizen Litigation Group, said that the organization was “extremely gratified” that the Court “upheld the traditional right of patients harmed by defective and mislabeled drugs to sue drug companies to recover compensation for their injuries.

In an eagerly anticipated opinion, the U.S. Supreme Court has upheld a lower court ruling that Food and Drug Administration approval does not give pharmaceutical companies immunity from product liability lawsuits.

The justices voted 6–3 to affirm the judgment of the Vermont Supreme Court that federal law did not preempt Diana Levine's claim of inadequate warning on the label of promethazine (Phenergan). Ms. Levine received the drug by intravenous push and subsequently lost her arm. She was awarded $6.7 million by a Vermont jury.

A majority of justices rejected the argument by Wyeth Pharmaceuticals Inc., maker of Phenergan, that it was impossible for the company to simultaneously comply with both federal and state laws and regulations.

Wyeth could have unilaterally strengthened the label at any time without input or clearance from the FDA, wrote the justices, concurring with the lower court opinion. And, the company's argument that following the duty to warn under state law would have interfered with the FDA's power to preempt state law was “meritless,” according to the majority opinion.

Justice Clarence Thomas voted with the majority, agreeing that Wyeth could have changed its label and complied with both state and federal laws. But he said that he did not agree with the majority's more far-reaching conclusions about preemption, specifically a tendency to override state laws when they were perceived to be an impediment to enforcing federal statutes.

Justice Samuel Alito and Justice Antonin Scalia, joined by Chief Justice John Roberts, dissented, writing in their opinion that “this case illustrates that tragic facts make bad law. The Court holds that a state tort jury, rather than the Food and Drug Administration, is ultimately responsible for regulating warning labels for prescription drugs.” That premise is not consistent with previous rulings, they wrote.

Indeed, just last year the U.S. Supreme Court ruled in Riegel v. Medtronic Inc., that FDA approval conferred special protection against product liability suits involving medical devices.

The Pharmaceutical Research and Manufacturers of America said that it was still reviewing the opinions in Wyeth v. Levine.

“We continue to believe that the expert scientists and medical professionals at the FDA are in the best position to evaluate the voluminous information about a medicine's benefits and risks and to determine which safety information to include in the drug label,” PhRMA Senior Vice President Ken Johnson said in a statement.

In an eagerly anticipated opinion, the U.S. Supreme Court has upheld a lower court ruling that Food and Drug Administration approval does not give pharmaceutical companies immunity from product liability lawsuits.

The justices voted 6–3 to affirm the judgment of the Vermont Supreme Court that federal law did not preempt Diana Levine's claim of inadequate warning on the label of promethazine (Phenergan). Ms. Levine received the drug by intravenous push and subsequently lost her arm. She was awarded $6.7 million by a Vermont jury.

A majority of justices rejected the argument by Wyeth Pharmaceuticals Inc., maker of Phenergan, that it was impossible for the company to simultaneously comply with both federal and state laws and regulations.

Wyeth could have unilaterally strengthened the label at any time without input or clearance from the FDA, wrote the justices, concurring with the lower court opinion. And, the company's argument that following the duty to warn under state law would have interfered with the FDA's power to preempt state law was “meritless,” according to the majority opinion.

Justice Clarence Thomas voted with the majority, agreeing that Wyeth could have changed its label and complied with both state and federal laws. But he said that he did not agree with the majority's more far-reaching conclusions about preemption, specifically a tendency to override state laws when they were perceived to be an impediment to enforcing federal statutes.

Justice Samuel Alito and Justice Antonin Scalia, joined by Chief Justice John Roberts, dissented, writing in their opinion that “this case illustrates that tragic facts make bad law. The Court holds that a state tort jury, rather than the Food and Drug Administration, is ultimately responsible for regulating warning labels for prescription drugs.” That premise is not consistent with previous rulings, they wrote.

Indeed, just last year the U.S. Supreme Court ruled in Riegel v. Medtronic Inc., that FDA approval conferred special protection against product liability suits involving medical devices.

The Pharmaceutical Research and Manufacturers of America said that it was still reviewing the opinions in Wyeth v. Levine.

“We continue to believe that the expert scientists and medical professionals at the FDA are in the best position to evaluate the voluminous information about a medicine's benefits and risks and to determine which safety information to include in the drug label,” PhRMA Senior Vice President Ken Johnson said in a statement.

In an eagerly anticipated opinion, the U.S. Supreme Court has upheld a lower court ruling that Food and Drug Administration approval does not give pharmaceutical companies immunity from product liability lawsuits.

The justices voted 6–3 to affirm the judgment of the Vermont Supreme Court that federal law did not preempt Diana Levine's claim of inadequate warning on the label of promethazine (Phenergan). Ms. Levine received the drug by intravenous push and subsequently lost her arm. She was awarded $6.7 million by a Vermont jury.

A majority of justices rejected the argument by Wyeth Pharmaceuticals Inc., maker of Phenergan, that it was impossible for the company to simultaneously comply with both federal and state laws and regulations.

Wyeth could have unilaterally strengthened the label at any time without input or clearance from the FDA, wrote the justices, concurring with the lower court opinion. And, the company's argument that following the duty to warn under state law would have interfered with the FDA's power to preempt state law was “meritless,” according to the majority opinion.

Justice Clarence Thomas voted with the majority, agreeing that Wyeth could have changed its label and complied with both state and federal laws. But he said that he did not agree with the majority's more far-reaching conclusions about preemption, specifically a tendency to override state laws when they were perceived to be an impediment to enforcing federal statutes.

Justice Samuel Alito and Justice Antonin Scalia, joined by Chief Justice John Roberts, dissented, writing in their opinion that “this case illustrates that tragic facts make bad law. The Court holds that a state tort jury, rather than the Food and Drug Administration, is ultimately responsible for regulating warning labels for prescription drugs.” That premise is not consistent with previous rulings, they wrote.

Indeed, just last year the U.S. Supreme Court ruled in Riegel v. Medtronic Inc., that FDA approval conferred special protection against product liability suits involving medical devices.

The Pharmaceutical Research and Manufacturers of America said that it was still reviewing the opinions in Wyeth v. Levine.

“We continue to believe that the expert scientists and medical professionals at the FDA are in the best position to evaluate the voluminous information about a medicine's benefits and risks and to determine which safety information to include in the drug label,” PhRMA Senior Vice President Ken Johnson said in a statement.

Grassley Digs Into Biederman

Sen. Chuck Grassley (R-Iowa) has tenaciously gone after what he sees as conflict of interest in the medical field, focusing closely on psychiatry. In the latest volley in his investigation into Dr. Joseph Biederman of Harvard University, Sen. Grassley said he was provided documents as part of ongoing litigation that appear to demonstrate that Dr. Biederman was acting in tandem with Johnson & Johnson to promote Concerta and other psychopharmacologics for off-label uses. Sen. Grassley sent a 63-page missive to the presidents of Harvard and the Massachusetts General Hospital outlining numerous apparent conflicts, including that Dr. Biederman was receiving $500,000 in grant money from the National Institutes of Health while he was running J&J's Center for Pediatric Psychopathology Research. Separately, in a letter to the New Jersey judge overseeing the litigation that peripherally involves Dr. Biederman, the psychiatrist's attorneys are seeking an order to prevent public disclosure of his deposition. Among other things in that deposition, when asked what rank followed full professor at Harvard, Dr. Biederman answered “God.”

Dementias Three Times as Costly

The latest report on Alzheimer's disease and other dementias from the Alzheimer's Association finds that Medicare pays out three times as much for beneficiaries with brain diseases, averaging $15,000 annually, compared with about $5,000 for those with no dementias. The 2009 report also found that 5.3 million Americans are living with AD. The organization expects 500,000 new cases a year in 2010, and a million per year by 2050. From 2000 to 2006, Alzheimer's disease deaths rose 47%, whereas deaths from other major diseases declined. The disease is also taking a toll on family members, who provide care for 70% of those with Alzheimer's. More states are querying caregivers about the impact. In Washington state, 48% of caregivers said stress was their greatest difficulty.

Painkiller Admissions on Rise

The Substance Abuse and Mental Health Services Administration (SAMHSA) is reporting that prescription painkiller misuse admissions have risen from 1% of total admissions in 1997 to 5% in 2007. The data come from the Treatment Episode Data Set 2007 Highlights report, which also found that alcohol-related admissions still account for the largest portion, but that they declined from 50% to 40% over the 10-year period. Heroin admissions have remained steady for a decade, at 14%, and methamphetamine admissions hit 8% in 2007, up from 4% in 1997. The dataset is not comprehensive, because it comes only from state-licensed treatment facilities.

Group Wants Ban on Industry CME

The consumer watchdog group Public Citizen has asked the American Medical Association to support a ban on commercial support of continuing medical education. In a letter to the chairs of the AMA's ethical and CME councils, Public Citizen's Health Research Group said that it wants the ban “because the consequences of any corrupting influence of commercial support on CME are so significant.” The group said that “physician-supported CME” is a viable alternative to commercial funding. The Pharmaceutical Research and Manufacturers of America said in a statement that a ban on commercial support of CME could prevent physicians from accessing critical information about treatments.

CNS Drugs Rank High in Cost

Medications that affect the central nervous system accounted for about $28 billion of the $208 billion American adults spent on prescription drugs in 2006, said the Agency for Healthcare Research and Quality. Metabolic drugs topped the list at $38 billion, cardiovascular drugs cost $33 billion, psychotherapeutic drugs cost more than $17 billion, and hormones cost $14 billion. The agency also found spending for outpatient prescription analgesics rose from about $4 billion in 1996 to more than $13 billion in 2006.

Boston Limits Tobacco Sales

Boston has banned tobacco-product sales at pharmacies and on college campuses. The Boston Public Health Commission's board of health also banned new permits for smoking bars, such as hookah and cigar bars, and prohibited the sale of blunt wraps, a tobacco leaf often used to roll marijuana. The board said it was working to increase access to smoking cessation resources. Last year, San Francisco imposed the first municipal ban on cigarette sales by pharmacies. Many college campuses already ban tobacco.

Physicians Postponing Retirement

Fewer physicians left group practices in 2008 than in 2007, and most group practice leaders believe that this change reflects more physicians' postponement of retirement because of the poor economy, said the American Medical Group Association. The group's annual survey of AMGA members reported about a 6% turnover of group practice physicians in 2008, compared with nearly 7% in 2007. The top reasons cited for leaving a group included poor fit with one's practice and the need to relocate to be closer to family. Flexibility can keep physicians in a practice, according to respondents, nearly half of whom said that part-time options encourage physicians either to stay while meeting personal needs, or to delay retirement.

Grassley Digs Into Biederman

Sen. Chuck Grassley (R-Iowa) has tenaciously gone after what he sees as conflict of interest in the medical field, focusing closely on psychiatry. In the latest volley in his investigation into Dr. Joseph Biederman of Harvard University, Sen. Grassley said he was provided documents as part of ongoing litigation that appear to demonstrate that Dr. Biederman was acting in tandem with Johnson & Johnson to promote Concerta and other psychopharmacologics for off-label uses. Sen. Grassley sent a 63-page missive to the presidents of Harvard and the Massachusetts General Hospital outlining numerous apparent conflicts, including that Dr. Biederman was receiving $500,000 in grant money from the National Institutes of Health while he was running J&J's Center for Pediatric Psychopathology Research. Separately, in a letter to the New Jersey judge overseeing the litigation that peripherally involves Dr. Biederman, the psychiatrist's attorneys are seeking an order to prevent public disclosure of his deposition. Among other things in that deposition, when asked what rank followed full professor at Harvard, Dr. Biederman answered “God.”

Dementias Three Times as Costly

The latest report on Alzheimer's disease and other dementias from the Alzheimer's Association finds that Medicare pays out three times as much for beneficiaries with brain diseases, averaging $15,000 annually, compared with about $5,000 for those with no dementias. The 2009 report also found that 5.3 million Americans are living with AD. The organization expects 500,000 new cases a year in 2010, and a million per year by 2050. From 2000 to 2006, Alzheimer's disease deaths rose 47%, whereas deaths from other major diseases declined. The disease is also taking a toll on family members, who provide care for 70% of those with Alzheimer's. More states are querying caregivers about the impact. In Washington state, 48% of caregivers said stress was their greatest difficulty.

Painkiller Admissions on Rise

The Substance Abuse and Mental Health Services Administration (SAMHSA) is reporting that prescription painkiller misuse admissions have risen from 1% of total admissions in 1997 to 5% in 2007. The data come from the Treatment Episode Data Set 2007 Highlights report, which also found that alcohol-related admissions still account for the largest portion, but that they declined from 50% to 40% over the 10-year period. Heroin admissions have remained steady for a decade, at 14%, and methamphetamine admissions hit 8% in 2007, up from 4% in 1997. The dataset is not comprehensive, because it comes only from state-licensed treatment facilities.

Group Wants Ban on Industry CME

The consumer watchdog group Public Citizen has asked the American Medical Association to support a ban on commercial support of continuing medical education. In a letter to the chairs of the AMA's ethical and CME councils, Public Citizen's Health Research Group said that it wants the ban “because the consequences of any corrupting influence of commercial support on CME are so significant.” The group said that “physician-supported CME” is a viable alternative to commercial funding. The Pharmaceutical Research and Manufacturers of America said in a statement that a ban on commercial support of CME could prevent physicians from accessing critical information about treatments.

CNS Drugs Rank High in Cost

Medications that affect the central nervous system accounted for about $28 billion of the $208 billion American adults spent on prescription drugs in 2006, said the Agency for Healthcare Research and Quality. Metabolic drugs topped the list at $38 billion, cardiovascular drugs cost $33 billion, psychotherapeutic drugs cost more than $17 billion, and hormones cost $14 billion. The agency also found spending for outpatient prescription analgesics rose from about $4 billion in 1996 to more than $13 billion in 2006.

Boston Limits Tobacco Sales

Boston has banned tobacco-product sales at pharmacies and on college campuses. The Boston Public Health Commission's board of health also banned new permits for smoking bars, such as hookah and cigar bars, and prohibited the sale of blunt wraps, a tobacco leaf often used to roll marijuana. The board said it was working to increase access to smoking cessation resources. Last year, San Francisco imposed the first municipal ban on cigarette sales by pharmacies. Many college campuses already ban tobacco.

Physicians Postponing Retirement

Fewer physicians left group practices in 2008 than in 2007, and most group practice leaders believe that this change reflects more physicians' postponement of retirement because of the poor economy, said the American Medical Group Association. The group's annual survey of AMGA members reported about a 6% turnover of group practice physicians in 2008, compared with nearly 7% in 2007. The top reasons cited for leaving a group included poor fit with one's practice and the need to relocate to be closer to family. Flexibility can keep physicians in a practice, according to respondents, nearly half of whom said that part-time options encourage physicians either to stay while meeting personal needs, or to delay retirement.

Grassley Digs Into Biederman

Sen. Chuck Grassley (R-Iowa) has tenaciously gone after what he sees as conflict of interest in the medical field, focusing closely on psychiatry. In the latest volley in his investigation into Dr. Joseph Biederman of Harvard University, Sen. Grassley said he was provided documents as part of ongoing litigation that appear to demonstrate that Dr. Biederman was acting in tandem with Johnson & Johnson to promote Concerta and other psychopharmacologics for off-label uses. Sen. Grassley sent a 63-page missive to the presidents of Harvard and the Massachusetts General Hospital outlining numerous apparent conflicts, including that Dr. Biederman was receiving $500,000 in grant money from the National Institutes of Health while he was running J&J's Center for Pediatric Psychopathology Research. Separately, in a letter to the New Jersey judge overseeing the litigation that peripherally involves Dr. Biederman, the psychiatrist's attorneys are seeking an order to prevent public disclosure of his deposition. Among other things in that deposition, when asked what rank followed full professor at Harvard, Dr. Biederman answered “God.”

Dementias Three Times as Costly

The latest report on Alzheimer's disease and other dementias from the Alzheimer's Association finds that Medicare pays out three times as much for beneficiaries with brain diseases, averaging $15,000 annually, compared with about $5,000 for those with no dementias. The 2009 report also found that 5.3 million Americans are living with AD. The organization expects 500,000 new cases a year in 2010, and a million per year by 2050. From 2000 to 2006, Alzheimer's disease deaths rose 47%, whereas deaths from other major diseases declined. The disease is also taking a toll on family members, who provide care for 70% of those with Alzheimer's. More states are querying caregivers about the impact. In Washington state, 48% of caregivers said stress was their greatest difficulty.

Painkiller Admissions on Rise

The Substance Abuse and Mental Health Services Administration (SAMHSA) is reporting that prescription painkiller misuse admissions have risen from 1% of total admissions in 1997 to 5% in 2007. The data come from the Treatment Episode Data Set 2007 Highlights report, which also found that alcohol-related admissions still account for the largest portion, but that they declined from 50% to 40% over the 10-year period. Heroin admissions have remained steady for a decade, at 14%, and methamphetamine admissions hit 8% in 2007, up from 4% in 1997. The dataset is not comprehensive, because it comes only from state-licensed treatment facilities.

Group Wants Ban on Industry CME

The consumer watchdog group Public Citizen has asked the American Medical Association to support a ban on commercial support of continuing medical education. In a letter to the chairs of the AMA's ethical and CME councils, Public Citizen's Health Research Group said that it wants the ban “because the consequences of any corrupting influence of commercial support on CME are so significant.” The group said that “physician-supported CME” is a viable alternative to commercial funding. The Pharmaceutical Research and Manufacturers of America said in a statement that a ban on commercial support of CME could prevent physicians from accessing critical information about treatments.

CNS Drugs Rank High in Cost

Medications that affect the central nervous system accounted for about $28 billion of the $208 billion American adults spent on prescription drugs in 2006, said the Agency for Healthcare Research and Quality. Metabolic drugs topped the list at $38 billion, cardiovascular drugs cost $33 billion, psychotherapeutic drugs cost more than $17 billion, and hormones cost $14 billion. The agency also found spending for outpatient prescription analgesics rose from about $4 billion in 1996 to more than $13 billion in 2006.

Boston Limits Tobacco Sales

Boston has banned tobacco-product sales at pharmacies and on college campuses. The Boston Public Health Commission's board of health also banned new permits for smoking bars, such as hookah and cigar bars, and prohibited the sale of blunt wraps, a tobacco leaf often used to roll marijuana. The board said it was working to increase access to smoking cessation resources. Last year, San Francisco imposed the first municipal ban on cigarette sales by pharmacies. Many college campuses already ban tobacco.

Physicians Postponing Retirement

Fewer physicians left group practices in 2008 than in 2007, and most group practice leaders believe that this change reflects more physicians' postponement of retirement because of the poor economy, said the American Medical Group Association. The group's annual survey of AMGA members reported about a 6% turnover of group practice physicians in 2008, compared with nearly 7% in 2007. The top reasons cited for leaving a group included poor fit with one's practice and the need to relocate to be closer to family. Flexibility can keep physicians in a practice, according to respondents, nearly half of whom said that part-time options encourage physicians either to stay while meeting personal needs, or to delay retirement.

WASHINGTON – Internet-based brief screening and self-help interventions for addictions provide an option for people who otherwise might not make it in to see a clinician in person, according to an addiction specialist who has been piloting such programs for alcohol and tobacco abuse.

Studies have shown that problem drinkers and gamblers, for instance, have ready access to the Internet and may be more likely to first seek help online rather than in a face-to-face encounter, said John A. Cunningham, Ph.D., a senior scientist at the Centre for Addiction and Mental Health, teaching hospital affiliated with the University of Toronto.

Dr. Cunningham, who spoke at the Association for Medical Education and Research in Substance Abuse, has worked as a consultant with Toronto-based V-CC Systems Inc., a company that develops and supports community-based interactive disease management programs.

One such tool can be found at www.checkyourdrinking.net

V-CC Systems has tried to evaluate whether using the screen changes behavior. It recruited study participants through random dialing, from which 185 people were selected. They were contacted 3 and 6 months after taking the brief screen. It was determined that those who had access to the Web site had reduced the number of drinks by 6 to 7 a week. It seemed that the screen was effective for people who had a drinking problem, but not as much so for other [addictions], said Dr. Cunningham.

Another V-CC site, www.alcoholhelpcenter.net

This site has not yet been evaluated in a formal study, but 650 posts to the online support groups have been analyzed, said Dr. Cunningham. A third of those were greetings and messages of support from support specialists, which is important because participants often are isolated and in need of such support. The support specialists are given specific instructions on how to “seed” discussions and respond to posts.

At the Stop Smoking Center (www.stopsmokingcenter.net

The Internet-based sites can be targeted to various audiences. For example, V-CC (www.v-cc.com

WASHINGTON – Internet-based brief screening and self-help interventions for addictions provide an option for people who otherwise might not make it in to see a clinician in person, according to an addiction specialist who has been piloting such programs for alcohol and tobacco abuse.

Studies have shown that problem drinkers and gamblers, for instance, have ready access to the Internet and may be more likely to first seek help online rather than in a face-to-face encounter, said John A. Cunningham, Ph.D., a senior scientist at the Centre for Addiction and Mental Health, teaching hospital affiliated with the University of Toronto.

Dr. Cunningham, who spoke at the Association for Medical Education and Research in Substance Abuse, has worked as a consultant with Toronto-based V-CC Systems Inc., a company that develops and supports community-based interactive disease management programs.

One such tool can be found at www.checkyourdrinking.net

V-CC Systems has tried to evaluate whether using the screen changes behavior. It recruited study participants through random dialing, from which 185 people were selected. They were contacted 3 and 6 months after taking the brief screen. It was determined that those who had access to the Web site had reduced the number of drinks by 6 to 7 a week. It seemed that the screen was effective for people who had a drinking problem, but not as much so for other [addictions], said Dr. Cunningham.

Another V-CC site, www.alcoholhelpcenter.net

This site has not yet been evaluated in a formal study, but 650 posts to the online support groups have been analyzed, said Dr. Cunningham. A third of those were greetings and messages of support from support specialists, which is important because participants often are isolated and in need of such support. The support specialists are given specific instructions on how to “seed” discussions and respond to posts.

At the Stop Smoking Center (www.stopsmokingcenter.net

The Internet-based sites can be targeted to various audiences. For example, V-CC (www.v-cc.com

WASHINGTON – Internet-based brief screening and self-help interventions for addictions provide an option for people who otherwise might not make it in to see a clinician in person, according to an addiction specialist who has been piloting such programs for alcohol and tobacco abuse.

Studies have shown that problem drinkers and gamblers, for instance, have ready access to the Internet and may be more likely to first seek help online rather than in a face-to-face encounter, said John A. Cunningham, Ph.D., a senior scientist at the Centre for Addiction and Mental Health, teaching hospital affiliated with the University of Toronto.

Dr. Cunningham, who spoke at the Association for Medical Education and Research in Substance Abuse, has worked as a consultant with Toronto-based V-CC Systems Inc., a company that develops and supports community-based interactive disease management programs.

One such tool can be found at www.checkyourdrinking.net

V-CC Systems has tried to evaluate whether using the screen changes behavior. It recruited study participants through random dialing, from which 185 people were selected. They were contacted 3 and 6 months after taking the brief screen. It was determined that those who had access to the Web site had reduced the number of drinks by 6 to 7 a week. It seemed that the screen was effective for people who had a drinking problem, but not as much so for other [addictions], said Dr. Cunningham.

Another V-CC site, www.alcoholhelpcenter.net

This site has not yet been evaluated in a formal study, but 650 posts to the online support groups have been analyzed, said Dr. Cunningham. A third of those were greetings and messages of support from support specialists, which is important because participants often are isolated and in need of such support. The support specialists are given specific instructions on how to “seed” discussions and respond to posts.

At the Stop Smoking Center (www.stopsmokingcenter.net

The Internet-based sites can be targeted to various audiences. For example, V-CC (www.v-cc.com

In an eagerly anticipated opinion, the U.S. Supreme Court has upheld a lower court ruling that Food and Drug Administration approval does not give pharmaceutical companies immunity from product liability lawsuits.

The justices voted 6–3 to affirm the judgment of the Vermont Supreme Court that federal law did not preempt Diana Levine's claim of inadequate warning on the label of promethazine (Phenergan). Ms. Levine received the drug by intravenous push and subsequently lost her arm. She was awarded $6.7 million by a Vermont jury.

A majority of justices rejected the argument by Wyeth Pharmaceuticals Inc., which manufactures Phenergan, that it was impossible for the company to simultaneously comply with both federal and state laws and regulations.

Wyeth could have unilaterally strengthened the label at any time without input or clearance from the FDA, wrote the justices, concurring with the lower court opinion. And the company's argument that following the duty to warn under state law would have interfered with the FDA's power to preempt state law was “meritless,” according to the majority opinion.

Justice Clarence Thomas voted with the majority, agreeing that Wyeth could have changed its label and complied with both state and federal laws. But he said that he did not agree with the majority's more far-reaching conclusions about preemption, specifically a tendency to override state laws when they were perceived to be an impediment to enforcing federal statutes.

Justice Samuel Alito and Justice Antonin Scalia, joined by Chief Justice John Roberts, dissented, writing in their opinion that “this case illustrates that tragic facts make bad law. The Court holds that a state tort jury, rather than the Food and Drug Administration, is ultimately responsible for regulating warning labels for prescription drugs.” That premise is not consistent with previous rulings, they wrote.

Indeed, just last year the U.S. Supreme Court ruled in Riegel v. Medtronic Inc. that FDA approval conferred special protection against product liability suits involving medical devices.

Consumer advocacy group Public Citizen called the ruling a broad rebuff to the industry's attempt to duck tort damages. Brian Wolfman, director of Public Citizen Litigation Group, said that the organization was “extremely gratified” that the Court “upheld the traditional right of patients harmed by defective and mislabeled drugs to sue drug companies to recover compensation for their injuries.”

In an eagerly anticipated opinion, the U.S. Supreme Court has upheld a lower court ruling that Food and Drug Administration approval does not give pharmaceutical companies immunity from product liability lawsuits.

The justices voted 6–3 to affirm the judgment of the Vermont Supreme Court that federal law did not preempt Diana Levine's claim of inadequate warning on the label of promethazine (Phenergan). Ms. Levine received the drug by intravenous push and subsequently lost her arm. She was awarded $6.7 million by a Vermont jury.

A majority of justices rejected the argument by Wyeth Pharmaceuticals Inc., which manufactures Phenergan, that it was impossible for the company to simultaneously comply with both federal and state laws and regulations.

Wyeth could have unilaterally strengthened the label at any time without input or clearance from the FDA, wrote the justices, concurring with the lower court opinion. And the company's argument that following the duty to warn under state law would have interfered with the FDA's power to preempt state law was “meritless,” according to the majority opinion.

Justice Clarence Thomas voted with the majority, agreeing that Wyeth could have changed its label and complied with both state and federal laws. But he said that he did not agree with the majority's more far-reaching conclusions about preemption, specifically a tendency to override state laws when they were perceived to be an impediment to enforcing federal statutes.

Justice Samuel Alito and Justice Antonin Scalia, joined by Chief Justice John Roberts, dissented, writing in their opinion that “this case illustrates that tragic facts make bad law. The Court holds that a state tort jury, rather than the Food and Drug Administration, is ultimately responsible for regulating warning labels for prescription drugs.” That premise is not consistent with previous rulings, they wrote.

Indeed, just last year the U.S. Supreme Court ruled in Riegel v. Medtronic Inc. that FDA approval conferred special protection against product liability suits involving medical devices.

Consumer advocacy group Public Citizen called the ruling a broad rebuff to the industry's attempt to duck tort damages. Brian Wolfman, director of Public Citizen Litigation Group, said that the organization was “extremely gratified” that the Court “upheld the traditional right of patients harmed by defective and mislabeled drugs to sue drug companies to recover compensation for their injuries.”

In an eagerly anticipated opinion, the U.S. Supreme Court has upheld a lower court ruling that Food and Drug Administration approval does not give pharmaceutical companies immunity from product liability lawsuits.

The justices voted 6–3 to affirm the judgment of the Vermont Supreme Court that federal law did not preempt Diana Levine's claim of inadequate warning on the label of promethazine (Phenergan). Ms. Levine received the drug by intravenous push and subsequently lost her arm. She was awarded $6.7 million by a Vermont jury.

A majority of justices rejected the argument by Wyeth Pharmaceuticals Inc., which manufactures Phenergan, that it was impossible for the company to simultaneously comply with both federal and state laws and regulations.

Wyeth could have unilaterally strengthened the label at any time without input or clearance from the FDA, wrote the justices, concurring with the lower court opinion. And the company's argument that following the duty to warn under state law would have interfered with the FDA's power to preempt state law was “meritless,” according to the majority opinion.

Justice Clarence Thomas voted with the majority, agreeing that Wyeth could have changed its label and complied with both state and federal laws. But he said that he did not agree with the majority's more far-reaching conclusions about preemption, specifically a tendency to override state laws when they were perceived to be an impediment to enforcing federal statutes.

Justice Samuel Alito and Justice Antonin Scalia, joined by Chief Justice John Roberts, dissented, writing in their opinion that “this case illustrates that tragic facts make bad law. The Court holds that a state tort jury, rather than the Food and Drug Administration, is ultimately responsible for regulating warning labels for prescription drugs.” That premise is not consistent with previous rulings, they wrote.

Indeed, just last year the U.S. Supreme Court ruled in Riegel v. Medtronic Inc. that FDA approval conferred special protection against product liability suits involving medical devices.

Consumer advocacy group Public Citizen called the ruling a broad rebuff to the industry's attempt to duck tort damages. Brian Wolfman, director of Public Citizen Litigation Group, said that the organization was “extremely gratified” that the Court “upheld the traditional right of patients harmed by defective and mislabeled drugs to sue drug companies to recover compensation for their injuries.”

UnitedHealth Group has decided to invest further in the medical home concept, despite a lack of demonstrated outcomes.

In 2009, the insurer will spend more than $1 million on “enhanced primary care payments,” said Eric Sullivan, national director of patient-centered medical home initiatives for the UnitedHealthcare unit.

The focus will be on projects in Arizona, Colorado, and Rhode Island. Each project is slightly different. In Colorado, UnitedHealthcare is part of the Chronic Care Sustainability Initiative, a multipayer demonstration project. UnitedHealthcare is joining with IBM in Arizona in an extensive project that will involve the reinvention of the practices of 24 physicians. The Rhode Island project is being administered by the state insurance commissioner and is a collaboration with United, the state Medicaid plan and the state Blue Cross and Blue Shield plan, Mr. Sullivan said in an interview.

The insurer will be using “all three pilots to inform our decisions going forward in terms of how we support comprehensive primary care,” Mr. Sullivan said. Researchers at Harvard's School of Public Health will be studying the Colorado and Rhode Island initiatives and publicly reporting on them. UnitedHealthcare will join with internal and external consultants to study the Arizona project. The findings will be shared with IBM, the physicians involved, and medical societies in the state.

TransforMED, the for-profit division of the American Academy of Family Physicians, has been consulting with UnitedHealthcare on its demonstration projects. Dr. Terry McGeeney, president and chief executive officer of TransforMED, advised that a certain amount of transparency would be wise in these projects, given that there's “always a certain amount of distrust between physicians and payers.”

As an example, he cited a UnitedHealthcare demonstration project in Florida that never got off the ground because the “timing wasn't right. In the Florida market at that time, there was a lot of distrust around motives.” Based on the many meetings he observed, United's expectations were “too much [for physicians] to digest.” (See editorial on p. 9.)

In Arizona, UnitedHealthcare is collaborating with IBM, which has been active in advancing the medical home concept. Seven primary care practices were selected. Each had a large volume of United enrollees, met United's definition of a high-quality provider, and agreed to transform into a medical home for all of their patients, and not just United enrollees. (Most IBM employees are covered by United.) The project covers only adult medicine, not pediatrics. The 24 physicians in the seven practices see 13,000–15,000 United enrollees in commercial, Medicare, and Medicaid plans, Mr. Sullivan explained.

UnitedHealthcare brought in TransforMED to help the practices retool into medical homes. The company will teach physicians how to change their practices, giving them advice and tools to enhance teamwork and more efficiently manage care, Dr. McGeeney said. The insurer will not be providing direct funds for purchase of electronic medical record systems, he said. Most of the practices taking part in the demonstration already have or are purchasing EMR systems.

One of the Arizona project participants is Dr. Jim Dearing, who is in solo practice in Phoenix. Dr. Dearing, who hasn't yet invested in EMRs because of the lack of interoperability standards, said he chose to join the project because he's barely making ends meet. He's already delivering high-quality care to some 25 patients a day, but he's still not efficient enough. Dr. Dearing said he hopes that TransforMED's advice and United's new reimbursement structure will help reinvigorate his practice.

The patient-centered medical home is a path into the future, he said in an interview. “If we don't try a product to make us better than where we are, we're not going to have a job.”

Under the UnitedHealthcare contract, participating physicians will receive a per member per month payment each quarter for the United members in their practice. The physicians also are eligible to receive a performance bonus.

Dr. Dearing is not without trepidation, however. “I'm scared to death about the costs,” he said, adding, “I'm scared to death about the implementation.”

“It's critically important that these pilots show positive outcomes so that the payment mechanisms can change,” Dr. McGeeney said. “There's too much soft data floating around out there now,” he said, adding that these UnitedHealthcare pilots should help provide some real proof of concept.

The Arizona demonstration runs for 3 years, and the Colorado and Rhode Island projects for 2 years, through 2011.

But Mr. Sullivan predicted that physicians, payers, and patients will know sooner rather than later about what works and what doesn't work with the projects.

UnitedHealth Group has decided to invest further in the medical home concept, despite a lack of demonstrated outcomes.

In 2009, the insurer will spend more than $1 million on “enhanced primary care payments,” said Eric Sullivan, national director of patient-centered medical home initiatives for the UnitedHealthcare unit.

The focus will be on projects in Arizona, Colorado, and Rhode Island. Each project is slightly different. In Colorado, UnitedHealthcare is part of the Chronic Care Sustainability Initiative, a multipayer demonstration project. UnitedHealthcare is joining with IBM in Arizona in an extensive project that will involve the reinvention of the practices of 24 physicians. The Rhode Island project is being administered by the state insurance commissioner and is a collaboration with United, the state Medicaid plan and the state Blue Cross and Blue Shield plan, Mr. Sullivan said in an interview.

The insurer will be using “all three pilots to inform our decisions going forward in terms of how we support comprehensive primary care,” Mr. Sullivan said. Researchers at Harvard's School of Public Health will be studying the Colorado and Rhode Island initiatives and publicly reporting on them. UnitedHealthcare will join with internal and external consultants to study the Arizona project. The findings will be shared with IBM, the physicians involved, and medical societies in the state.

TransforMED, the for-profit division of the American Academy of Family Physicians, has been consulting with UnitedHealthcare on its demonstration projects. Dr. Terry McGeeney, president and chief executive officer of TransforMED, advised that a certain amount of transparency would be wise in these projects, given that there's “always a certain amount of distrust between physicians and payers.”

As an example, he cited a UnitedHealthcare demonstration project in Florida that never got off the ground because the “timing wasn't right. In the Florida market at that time, there was a lot of distrust around motives.” Based on the many meetings he observed, United's expectations were “too much [for physicians] to digest.” (See editorial on p. 9.)

In Arizona, UnitedHealthcare is collaborating with IBM, which has been active in advancing the medical home concept. Seven primary care practices were selected. Each had a large volume of United enrollees, met United's definition of a high-quality provider, and agreed to transform into a medical home for all of their patients, and not just United enrollees. (Most IBM employees are covered by United.) The project covers only adult medicine, not pediatrics. The 24 physicians in the seven practices see 13,000–15,000 United enrollees in commercial, Medicare, and Medicaid plans, Mr. Sullivan explained.

UnitedHealthcare brought in TransforMED to help the practices retool into medical homes. The company will teach physicians how to change their practices, giving them advice and tools to enhance teamwork and more efficiently manage care, Dr. McGeeney said. The insurer will not be providing direct funds for purchase of electronic medical record systems, he said. Most of the practices taking part in the demonstration already have or are purchasing EMR systems.

One of the Arizona project participants is Dr. Jim Dearing, who is in solo practice in Phoenix. Dr. Dearing, who hasn't yet invested in EMRs because of the lack of interoperability standards, said he chose to join the project because he's barely making ends meet. He's already delivering high-quality care to some 25 patients a day, but he's still not efficient enough. Dr. Dearing said he hopes that TransforMED's advice and United's new reimbursement structure will help reinvigorate his practice.

The patient-centered medical home is a path into the future, he said in an interview. “If we don't try a product to make us better than where we are, we're not going to have a job.”

Under the UnitedHealthcare contract, participating physicians will receive a per member per month payment each quarter for the United members in their practice. The physicians also are eligible to receive a performance bonus.

Dr. Dearing is not without trepidation, however. “I'm scared to death about the costs,” he said, adding, “I'm scared to death about the implementation.”

“It's critically important that these pilots show positive outcomes so that the payment mechanisms can change,” Dr. McGeeney said. “There's too much soft data floating around out there now,” he said, adding that these UnitedHealthcare pilots should help provide some real proof of concept.

The Arizona demonstration runs for 3 years, and the Colorado and Rhode Island projects for 2 years, through 2011.

But Mr. Sullivan predicted that physicians, payers, and patients will know sooner rather than later about what works and what doesn't work with the projects.

UnitedHealth Group has decided to invest further in the medical home concept, despite a lack of demonstrated outcomes.

In 2009, the insurer will spend more than $1 million on “enhanced primary care payments,” said Eric Sullivan, national director of patient-centered medical home initiatives for the UnitedHealthcare unit.

The focus will be on projects in Arizona, Colorado, and Rhode Island. Each project is slightly different. In Colorado, UnitedHealthcare is part of the Chronic Care Sustainability Initiative, a multipayer demonstration project. UnitedHealthcare is joining with IBM in Arizona in an extensive project that will involve the reinvention of the practices of 24 physicians. The Rhode Island project is being administered by the state insurance commissioner and is a collaboration with United, the state Medicaid plan and the state Blue Cross and Blue Shield plan, Mr. Sullivan said in an interview.

The insurer will be using “all three pilots to inform our decisions going forward in terms of how we support comprehensive primary care,” Mr. Sullivan said. Researchers at Harvard's School of Public Health will be studying the Colorado and Rhode Island initiatives and publicly reporting on them. UnitedHealthcare will join with internal and external consultants to study the Arizona project. The findings will be shared with IBM, the physicians involved, and medical societies in the state.

TransforMED, the for-profit division of the American Academy of Family Physicians, has been consulting with UnitedHealthcare on its demonstration projects. Dr. Terry McGeeney, president and chief executive officer of TransforMED, advised that a certain amount of transparency would be wise in these projects, given that there's “always a certain amount of distrust between physicians and payers.”

As an example, he cited a UnitedHealthcare demonstration project in Florida that never got off the ground because the “timing wasn't right. In the Florida market at that time, there was a lot of distrust around motives.” Based on the many meetings he observed, United's expectations were “too much [for physicians] to digest.” (See editorial on p. 9.)

In Arizona, UnitedHealthcare is collaborating with IBM, which has been active in advancing the medical home concept. Seven primary care practices were selected. Each had a large volume of United enrollees, met United's definition of a high-quality provider, and agreed to transform into a medical home for all of their patients, and not just United enrollees. (Most IBM employees are covered by United.) The project covers only adult medicine, not pediatrics. The 24 physicians in the seven practices see 13,000–15,000 United enrollees in commercial, Medicare, and Medicaid plans, Mr. Sullivan explained.

UnitedHealthcare brought in TransforMED to help the practices retool into medical homes. The company will teach physicians how to change their practices, giving them advice and tools to enhance teamwork and more efficiently manage care, Dr. McGeeney said. The insurer will not be providing direct funds for purchase of electronic medical record systems, he said. Most of the practices taking part in the demonstration already have or are purchasing EMR systems.

One of the Arizona project participants is Dr. Jim Dearing, who is in solo practice in Phoenix. Dr. Dearing, who hasn't yet invested in EMRs because of the lack of interoperability standards, said he chose to join the project because he's barely making ends meet. He's already delivering high-quality care to some 25 patients a day, but he's still not efficient enough. Dr. Dearing said he hopes that TransforMED's advice and United's new reimbursement structure will help reinvigorate his practice.

The patient-centered medical home is a path into the future, he said in an interview. “If we don't try a product to make us better than where we are, we're not going to have a job.”

Under the UnitedHealthcare contract, participating physicians will receive a per member per month payment each quarter for the United members in their practice. The physicians also are eligible to receive a performance bonus.

Dr. Dearing is not without trepidation, however. “I'm scared to death about the costs,” he said, adding, “I'm scared to death about the implementation.”

“It's critically important that these pilots show positive outcomes so that the payment mechanisms can change,” Dr. McGeeney said. “There's too much soft data floating around out there now,” he said, adding that these UnitedHealthcare pilots should help provide some real proof of concept.

The Arizona demonstration runs for 3 years, and the Colorado and Rhode Island projects for 2 years, through 2011.

But Mr. Sullivan predicted that physicians, payers, and patients will know sooner rather than later about what works and what doesn't work with the projects.

WASHINGTON — Pharmaceutical companies are turning to social networking to reach their customers—both physicians and patients—as it's become increasingly difficult to market using traditional approaches.

At a meeting sponsored by a Washington-based public relations company, Waggener Edstrom Worldwide, staffs from drug companies and public relations firms brainstormed on how to maximize opportunities presented by social-networking sites like Facebook and Twitter without running afoul of regulations.

The Food and Drug Administration has not determined where—and exactly how—social networking fits into its regulatory construct. Sanjay J. Koyani, director of FDA Web communications, said that the agency was using social networking tools to advance its own goals—for instance, with a Twitter page devoted to tweets (messages of 140 characters or fewer) about agency recalls—but that it is still working out how it would regulate messages presented by pharmaceutical companies.

Even so, the FDA tends to apply current regulations to digital communications, according to an analysis by Waggener Edstrom. Companies are required to present a fair balance between benefit and risk, and may not promote off-label uses.

Mark Gaydos, a senior director of regulatory affairs at Sanofi-Aventis, said he is heading an informal task force of representatives from five drug makers seeking to create voluntary guidelines on the industry's use of social media. The companies have talked with the FDA Division of Drug Marketing, Advertising, and Communications about their efforts, Mr. Gaydos said.

"We're trying to influence the environment [and] shape the policy in some way, because the guidelines aren't out there and it's really preventing a lot of companies from participating, so we're hoping we can move that along," he said.

Drug makers know that their customers are increasingly online, and that's where the drug makers need to be, too, said Mr. Gaydos, who pointed out that he expressed his own opinions, not those of Sanofi-Aventis. "The traditional massive sales force approach is really not doing the job anymore," he said.

Even if the industry figures out how to stay within the confines of eventual FDA rules, it will still face a balancing act when it taps into social media.

Promulgating announcements about products—even approved therapies—through regular social media messages could end up just annoying recipients. And participating in patient-led chats or "friending" a Parkinson's disease patient group on Facebook, for example, could present perils. Drug makers don't want to be seen as predatory.

"A company has to tread lightly because [it doesn't] want to be perceived as using a social media venue as just another way to promote," Mr. Gaydos said.

Some drug makers—including Astra-Zeneca Pharmaceuticals LP, Boehringer Ingelheim GmbH, Novartis, and Vertex Pharmaceuticals Inc.—have begun using Twitter. Only Boehringer seems to be fairly active; even so, it sent only 33 updates via Twitter since last November.

Companies seem to be using Twitter primarily to follow others on the service, said Jenny Moede, who advises drug companies on digital media for Waggener Edstrom. That said, no one at the meeting expected drug makers to follow passively for too much longer.

WASHINGTON — Pharmaceutical companies are turning to social networking to reach their customers—both physicians and patients—as it's become increasingly difficult to market using traditional approaches.

At a meeting sponsored by a Washington-based public relations company, Waggener Edstrom Worldwide, staffs from drug companies and public relations firms brainstormed on how to maximize opportunities presented by social-networking sites like Facebook and Twitter without running afoul of regulations.

The Food and Drug Administration has not determined where—and exactly how—social networking fits into its regulatory construct. Sanjay J. Koyani, director of FDA Web communications, said that the agency was using social networking tools to advance its own goals—for instance, with a Twitter page devoted to tweets (messages of 140 characters or fewer) about agency recalls—but that it is still working out how it would regulate messages presented by pharmaceutical companies.

Even so, the FDA tends to apply current regulations to digital communications, according to an analysis by Waggener Edstrom. Companies are required to present a fair balance between benefit and risk, and may not promote off-label uses.

Mark Gaydos, a senior director of regulatory affairs at Sanofi-Aventis, said he is heading an informal task force of representatives from five drug makers seeking to create voluntary guidelines on the industry's use of social media. The companies have talked with the FDA Division of Drug Marketing, Advertising, and Communications about their efforts, Mr. Gaydos said.

"We're trying to influence the environment [and] shape the policy in some way, because the guidelines aren't out there and it's really preventing a lot of companies from participating, so we're hoping we can move that along," he said.

Drug makers know that their customers are increasingly online, and that's where the drug makers need to be, too, said Mr. Gaydos, who pointed out that he expressed his own opinions, not those of Sanofi-Aventis. "The traditional massive sales force approach is really not doing the job anymore," he said.

Even if the industry figures out how to stay within the confines of eventual FDA rules, it will still face a balancing act when it taps into social media.

Promulgating announcements about products—even approved therapies—through regular social media messages could end up just annoying recipients. And participating in patient-led chats or "friending" a Parkinson's disease patient group on Facebook, for example, could present perils. Drug makers don't want to be seen as predatory.

"A company has to tread lightly because [it doesn't] want to be perceived as using a social media venue as just another way to promote," Mr. Gaydos said.

Some drug makers—including Astra-Zeneca Pharmaceuticals LP, Boehringer Ingelheim GmbH, Novartis, and Vertex Pharmaceuticals Inc.—have begun using Twitter. Only Boehringer seems to be fairly active; even so, it sent only 33 updates via Twitter since last November.

Companies seem to be using Twitter primarily to follow others on the service, said Jenny Moede, who advises drug companies on digital media for Waggener Edstrom. That said, no one at the meeting expected drug makers to follow passively for too much longer.

WASHINGTON — Pharmaceutical companies are turning to social networking to reach their customers—both physicians and patients—as it's become increasingly difficult to market using traditional approaches.

At a meeting sponsored by a Washington-based public relations company, Waggener Edstrom Worldwide, staffs from drug companies and public relations firms brainstormed on how to maximize opportunities presented by social-networking sites like Facebook and Twitter without running afoul of regulations.

The Food and Drug Administration has not determined where—and exactly how—social networking fits into its regulatory construct. Sanjay J. Koyani, director of FDA Web communications, said that the agency was using social networking tools to advance its own goals—for instance, with a Twitter page devoted to tweets (messages of 140 characters or fewer) about agency recalls—but that it is still working out how it would regulate messages presented by pharmaceutical companies.

Even so, the FDA tends to apply current regulations to digital communications, according to an analysis by Waggener Edstrom. Companies are required to present a fair balance between benefit and risk, and may not promote off-label uses.

Mark Gaydos, a senior director of regulatory affairs at Sanofi-Aventis, said he is heading an informal task force of representatives from five drug makers seeking to create voluntary guidelines on the industry's use of social media. The companies have talked with the FDA Division of Drug Marketing, Advertising, and Communications about their efforts, Mr. Gaydos said.

"We're trying to influence the environment [and] shape the policy in some way, because the guidelines aren't out there and it's really preventing a lot of companies from participating, so we're hoping we can move that along," he said.

Drug makers know that their customers are increasingly online, and that's where the drug makers need to be, too, said Mr. Gaydos, who pointed out that he expressed his own opinions, not those of Sanofi-Aventis. "The traditional massive sales force approach is really not doing the job anymore," he said.

Even if the industry figures out how to stay within the confines of eventual FDA rules, it will still face a balancing act when it taps into social media.

Promulgating announcements about products—even approved therapies—through regular social media messages could end up just annoying recipients. And participating in patient-led chats or "friending" a Parkinson's disease patient group on Facebook, for example, could present perils. Drug makers don't want to be seen as predatory.

"A company has to tread lightly because [it doesn't] want to be perceived as using a social media venue as just another way to promote," Mr. Gaydos said.

Some drug makers—including Astra-Zeneca Pharmaceuticals LP, Boehringer Ingelheim GmbH, Novartis, and Vertex Pharmaceuticals Inc.—have begun using Twitter. Only Boehringer seems to be fairly active; even so, it sent only 33 updates via Twitter since last November.

Companies seem to be using Twitter primarily to follow others on the service, said Jenny Moede, who advises drug companies on digital media for Waggener Edstrom. That said, no one at the meeting expected drug makers to follow passively for too much longer.

CMS Mulls Facial Lipodystrophy

The Centers for Medicare and Medicaid Services is considering whether to cover reconstructive therapies for facial lipodystrophy, which would include Sanofi Aventis' Sculptra and BioForm Medical's Radiesse. The decision was requested by Dr. Bruce Wilder, an attorney representing an unknown client, and by two attorneys at the University of Pittsburgh School of Law. Facial lipodystrophy can occur in some individuals taking anti-retroviral medication against HIV. The agency indicated it would make a final decision by October.

Elesclomol Trial Suspended

Synta Pharmaceuticals Corp. has suspended a phase III study of elesclomol for stage IV melanoma. According to the company, a safety committee found that more deaths were occurring among patients receiving elesclomol and paclitaxel than among those getting paclitaxel alone. The company also decided to halt two other studies of elesclomol, one of the drug combined with docetaxel against hormone-refractory metastatic prostate cancer and the other, a dose-escalation study in patients with solid tumors. Synta President and CEO Safi Bahcall said in a statement that the company "will present detailed results in an appropriate scientific venue as soon as a full analysis has been completed."

Psoriasis Act Is Reintroduced

A small bipartisan group of lawmakers has reintroduced The Psoriasis and Psoriatic Arthritis Research Cure and Care Act (H.R. 930). It calls on the National Institutes of Health to support research on genetic markers and joint inflammation and destruction. It also directs the Centers for Disease Control and Prevention to develop a registry of psoriasis and psoriatic arthritis patients, and directs the Institute of Medicine to study the costs and health insurance coverage of these conditions. "We are seeking to foster understandings between research physicians in different specialties," said bill cosponsor Rep. David Wu (D-Ore.) in a statement. The legislation was introduced in 2007 but failed to pass. The act's lead advocate in the Senate is Sen. Robert Menendez (D-N.J.).

Silicone/Saline Combo Toxic

A Tampa woman was issued a citation for practicing medicine without a license after injecting several women with a combination of silicone and saline that was meant to enhance their buttocks. The Hillsborough County Sheriff's Department reported that the first woman paid $500 for 40 injections of hydrogel and saline, and that the second paid $250 for 20 injections. Shortly afterward, both experienced pain and discomfort and were taken to Town and Country Hospital. The injector, Sharhonda Lindsay, turned herself in after a warrant was issued for her arrest.

Group Wants Ban on Industry CME

The consumer watchdog group Public Citizen has asked the American Medical Association to support a ban on commercial support of continuing medical education. In a letter to the chairs of the AMA's ethical and CME councils, Public Citizen's Health Research Group said that it wants the ban "because the consequences of any corrupting influence of commercial support on CME are so significant." The group said that "physician-supported CME" is a viable alternative to commercial funding. The Pharmaceutical Research and Manufacturers of America said in a statement that a ban on commercial support of CME could prevent physicians from accessing critical information about treatments.

Physicians Postponing Retirement

Fewer physicians left group practices in 2008 than in 2007, and a majority of group practice leaders believe that the change reflects more physicians delaying retirement because of the poor economy, said the American Medical Group Association. The group's annual survey of AMGA members reported about a 6% turnover of group practice physicians in 2008, compared with nearly 7% in 2007. The top reasons cited for leaving a group included poor fit with one's practice and need to relocate to be closer to family. Flexibility can keep physicians in a practice, according to respondents, nearly half of whom said part-time options encourage physicians to stay while meeting personal needs or to delay retirement. Almost three-quarters of group practices offer preretirement physicians reduced hours, 56% allow for no call responsibility, and 20% allow concentration on certain patient groups.

CMS Mulls Facial Lipodystrophy

The Centers for Medicare and Medicaid Services is considering whether to cover reconstructive therapies for facial lipodystrophy, which would include Sanofi Aventis' Sculptra and BioForm Medical's Radiesse. The decision was requested by Dr. Bruce Wilder, an attorney representing an unknown client, and by two attorneys at the University of Pittsburgh School of Law. Facial lipodystrophy can occur in some individuals taking anti-retroviral medication against HIV. The agency indicated it would make a final decision by October.

Elesclomol Trial Suspended

Synta Pharmaceuticals Corp. has suspended a phase III study of elesclomol for stage IV melanoma. According to the company, a safety committee found that more deaths were occurring among patients receiving elesclomol and paclitaxel than among those getting paclitaxel alone. The company also decided to halt two other studies of elesclomol, one of the drug combined with docetaxel against hormone-refractory metastatic prostate cancer and the other, a dose-escalation study in patients with solid tumors. Synta President and CEO Safi Bahcall said in a statement that the company "will present detailed results in an appropriate scientific venue as soon as a full analysis has been completed."

Psoriasis Act Is Reintroduced

A small bipartisan group of lawmakers has reintroduced The Psoriasis and Psoriatic Arthritis Research Cure and Care Act (H.R. 930). It calls on the National Institutes of Health to support research on genetic markers and joint inflammation and destruction. It also directs the Centers for Disease Control and Prevention to develop a registry of psoriasis and psoriatic arthritis patients, and directs the Institute of Medicine to study the costs and health insurance coverage of these conditions. "We are seeking to foster understandings between research physicians in different specialties," said bill cosponsor Rep. David Wu (D-Ore.) in a statement. The legislation was introduced in 2007 but failed to pass. The act's lead advocate in the Senate is Sen. Robert Menendez (D-N.J.).

Silicone/Saline Combo Toxic

A Tampa woman was issued a citation for practicing medicine without a license after injecting several women with a combination of silicone and saline that was meant to enhance their buttocks. The Hillsborough County Sheriff's Department reported that the first woman paid $500 for 40 injections of hydrogel and saline, and that the second paid $250 for 20 injections. Shortly afterward, both experienced pain and discomfort and were taken to Town and Country Hospital. The injector, Sharhonda Lindsay, turned herself in after a warrant was issued for her arrest.

Group Wants Ban on Industry CME

The consumer watchdog group Public Citizen has asked the American Medical Association to support a ban on commercial support of continuing medical education. In a letter to the chairs of the AMA's ethical and CME councils, Public Citizen's Health Research Group said that it wants the ban "because the consequences of any corrupting influence of commercial support on CME are so significant." The group said that "physician-supported CME" is a viable alternative to commercial funding. The Pharmaceutical Research and Manufacturers of America said in a statement that a ban on commercial support of CME could prevent physicians from accessing critical information about treatments.

Physicians Postponing Retirement

Fewer physicians left group practices in 2008 than in 2007, and a majority of group practice leaders believe that the change reflects more physicians delaying retirement because of the poor economy, said the American Medical Group Association. The group's annual survey of AMGA members reported about a 6% turnover of group practice physicians in 2008, compared with nearly 7% in 2007. The top reasons cited for leaving a group included poor fit with one's practice and need to relocate to be closer to family. Flexibility can keep physicians in a practice, according to respondents, nearly half of whom said part-time options encourage physicians to stay while meeting personal needs or to delay retirement. Almost three-quarters of group practices offer preretirement physicians reduced hours, 56% allow for no call responsibility, and 20% allow concentration on certain patient groups.

CMS Mulls Facial Lipodystrophy

The Centers for Medicare and Medicaid Services is considering whether to cover reconstructive therapies for facial lipodystrophy, which would include Sanofi Aventis' Sculptra and BioForm Medical's Radiesse. The decision was requested by Dr. Bruce Wilder, an attorney representing an unknown client, and by two attorneys at the University of Pittsburgh School of Law. Facial lipodystrophy can occur in some individuals taking anti-retroviral medication against HIV. The agency indicated it would make a final decision by October.

Elesclomol Trial Suspended

Synta Pharmaceuticals Corp. has suspended a phase III study of elesclomol for stage IV melanoma. According to the company, a safety committee found that more deaths were occurring among patients receiving elesclomol and paclitaxel than among those getting paclitaxel alone. The company also decided to halt two other studies of elesclomol, one of the drug combined with docetaxel against hormone-refractory metastatic prostate cancer and the other, a dose-escalation study in patients with solid tumors. Synta President and CEO Safi Bahcall said in a statement that the company "will present detailed results in an appropriate scientific venue as soon as a full analysis has been completed."

Psoriasis Act Is Reintroduced

A small bipartisan group of lawmakers has reintroduced The Psoriasis and Psoriatic Arthritis Research Cure and Care Act (H.R. 930). It calls on the National Institutes of Health to support research on genetic markers and joint inflammation and destruction. It also directs the Centers for Disease Control and Prevention to develop a registry of psoriasis and psoriatic arthritis patients, and directs the Institute of Medicine to study the costs and health insurance coverage of these conditions. "We are seeking to foster understandings between research physicians in different specialties," said bill cosponsor Rep. David Wu (D-Ore.) in a statement. The legislation was introduced in 2007 but failed to pass. The act's lead advocate in the Senate is Sen. Robert Menendez (D-N.J.).

Silicone/Saline Combo Toxic

A Tampa woman was issued a citation for practicing medicine without a license after injecting several women with a combination of silicone and saline that was meant to enhance their buttocks. The Hillsborough County Sheriff's Department reported that the first woman paid $500 for 40 injections of hydrogel and saline, and that the second paid $250 for 20 injections. Shortly afterward, both experienced pain and discomfort and were taken to Town and Country Hospital. The injector, Sharhonda Lindsay, turned herself in after a warrant was issued for her arrest.

Group Wants Ban on Industry CME

The consumer watchdog group Public Citizen has asked the American Medical Association to support a ban on commercial support of continuing medical education. In a letter to the chairs of the AMA's ethical and CME councils, Public Citizen's Health Research Group said that it wants the ban "because the consequences of any corrupting influence of commercial support on CME are so significant." The group said that "physician-supported CME" is a viable alternative to commercial funding. The Pharmaceutical Research and Manufacturers of America said in a statement that a ban on commercial support of CME could prevent physicians from accessing critical information about treatments.

Physicians Postponing Retirement

Fewer physicians left group practices in 2008 than in 2007, and a majority of group practice leaders believe that the change reflects more physicians delaying retirement because of the poor economy, said the American Medical Group Association. The group's annual survey of AMGA members reported about a 6% turnover of group practice physicians in 2008, compared with nearly 7% in 2007. The top reasons cited for leaving a group included poor fit with one's practice and need to relocate to be closer to family. Flexibility can keep physicians in a practice, according to respondents, nearly half of whom said part-time options encourage physicians to stay while meeting personal needs or to delay retirement. Almost three-quarters of group practices offer preretirement physicians reduced hours, 56% allow for no call responsibility, and 20% allow concentration on certain patient groups.

UnitedHealth Group has decided to invest further in the medical home concept, despite a lack of demonstrated outcomes.

In 2009, the insurer will spend more than $1 million on “enhanced primary care payments,” said Eric Sullivan, national director of patient-centered medical home initiatives for the UnitedHealthcare unit.

The focus will be on projects in Colorado, Rhode Island and Arizona. Each project is slightly different. In Colorado, UnitedHealthcare is part of the Chronic Care Sustainability Initiative, a multi-payer demonstration project. UnitedHealthcare is joining with I.B.M. in Arizona in an extensive project that will involve the re-invention of the practices of 24 physicians. The Rhode Island project is being administered by the state insurance commissioner and is a collaboration with United, the state Medicaid plan and the state Blue Cross and Blue Shield plan, Mr. Sullivan said in an interview.

The insurer will be using “all three pilots to inform our decisions going forward in terms of how we support comprehensive primary care,” Mr. Sullivan said. Researchers at Harvard's School of Public Health will be studying the Colorado and Rhode Island initiatives and publicly reporting on them. UnitedHealthcare will join with internal and external consultants to study the Arizona project. The findings will be shared with I.B.M., the physicians involved, and medical societies in the state.

TransforMED, the for-profit division of the American Academy of Family Physicians, has been consulting with UnitedHealthcare on its demonstration projects. Dr. Terry McGeeney, president and chief executive officer of TransforMED, advised that a certain amount of transparency would be wise in these projects, given that there's “always a certain amount of distrust between physicians and payers.”

As an example, he cited a UnitedHealthcare demonstration project in Florida that never got off the ground because the “timing wasn't right. In the Florida market at that time, there was a lot of distrust around motives.” Based on the many meetings he observed, United's expectations were “too much [for physicians] to digest.”

In Arizona, UnitedHealthcare is collaborating with I.B.M., which has been active in advancing the medical home concept. Seven primary care practices were selected. Each had a large volume of United enrollees, met United's definition of a high-quality provider, and agreed to transform into a medical home for all of their patients, and not just United enrollees (Most I.B.M. employees are covered by United.)

The project only covers adult medicine, not pediatrics. The 24 physicians in the seven practices see 13,000-15,000 United enrollees, in commercial, Medicare and Medicaid plans, Mr. Sullivan explained.

UnitedHealthcare brought in—and paid for—TransforMED to help the practices retool into medical homes. The company will teach physicians how to change their practices, giving them advice and tools to enhance teamwork and more efficiently manage care, Dr. McGeeney said. The insurer will not be providing any direct funds for purchase of staff or electronic medical record hardware or software, he said. Most of the practices taking part in the demonstration already have or are purchasing EMR systems.

One of the Arizona project participants is Phoenix physician Jim Dearing, an AAFP board member in a solo practice. Dr. Dearing hasn't yet invested in EMRs because of the lack of interoperability standards. He said he chose to join the project because he's barely making ends meet. He's already delivering high-quality care to some 25 patients a day, but he's still not efficient enough. Dr. Dearing said he hopes that TransforMED's advice and United's new reimbursement structure will help reinvigorate his practice.

The patient-centered medical home is a path into the future, he said in an interview. “If we don't try a product to make us better than where we are, we're not going to have a job.”

Under the UnitedHealthcare contract, participating physicians will receive a per member per month payment each quarter for the United members in their practice. The physicians also are eligible to receive a performance bonus retrospectively, based on whether they meet key quality measures.

Dr. Dearing is not without trepidation, however. “I'm scared to death about the costs,” he said, adding, “I'm scared to death about the implementation.”

“It's critically important that these pilots show positive outcomes so that the payment mechanisms can change,” Dr. McGeeney said. “There's too much soft data floating around out there now,” he said, adding that these UnitedHealthcare pilots should help provide some real proof of concept.

The Arizona demonstration runs for 3 years, and the Colorado and Rhode Island projects for 2 years, through 2011.

But Mr. Sullivan predicted that physicians, payers, and patients will know sooner, rather than later, about what works and what doesn't work with the projects.

UnitedHealth Group has decided to invest further in the medical home concept, despite a lack of demonstrated outcomes.

In 2009, the insurer will spend more than $1 million on “enhanced primary care payments,” said Eric Sullivan, national director of patient-centered medical home initiatives for the UnitedHealthcare unit.

The focus will be on projects in Colorado, Rhode Island and Arizona. Each project is slightly different. In Colorado, UnitedHealthcare is part of the Chronic Care Sustainability Initiative, a multi-payer demonstration project. UnitedHealthcare is joining with I.B.M. in Arizona in an extensive project that will involve the re-invention of the practices of 24 physicians. The Rhode Island project is being administered by the state insurance commissioner and is a collaboration with United, the state Medicaid plan and the state Blue Cross and Blue Shield plan, Mr. Sullivan said in an interview.

The insurer will be using “all three pilots to inform our decisions going forward in terms of how we support comprehensive primary care,” Mr. Sullivan said. Researchers at Harvard's School of Public Health will be studying the Colorado and Rhode Island initiatives and publicly reporting on them. UnitedHealthcare will join with internal and external consultants to study the Arizona project. The findings will be shared with I.B.M., the physicians involved, and medical societies in the state.

TransforMED, the for-profit division of the American Academy of Family Physicians, has been consulting with UnitedHealthcare on its demonstration projects. Dr. Terry McGeeney, president and chief executive officer of TransforMED, advised that a certain amount of transparency would be wise in these projects, given that there's “always a certain amount of distrust between physicians and payers.”

As an example, he cited a UnitedHealthcare demonstration project in Florida that never got off the ground because the “timing wasn't right. In the Florida market at that time, there was a lot of distrust around motives.” Based on the many meetings he observed, United's expectations were “too much [for physicians] to digest.”

In Arizona, UnitedHealthcare is collaborating with I.B.M., which has been active in advancing the medical home concept. Seven primary care practices were selected. Each had a large volume of United enrollees, met United's definition of a high-quality provider, and agreed to transform into a medical home for all of their patients, and not just United enrollees (Most I.B.M. employees are covered by United.)

The project only covers adult medicine, not pediatrics. The 24 physicians in the seven practices see 13,000-15,000 United enrollees, in commercial, Medicare and Medicaid plans, Mr. Sullivan explained.

UnitedHealthcare brought in—and paid for—TransforMED to help the practices retool into medical homes. The company will teach physicians how to change their practices, giving them advice and tools to enhance teamwork and more efficiently manage care, Dr. McGeeney said. The insurer will not be providing any direct funds for purchase of staff or electronic medical record hardware or software, he said. Most of the practices taking part in the demonstration already have or are purchasing EMR systems.

One of the Arizona project participants is Phoenix physician Jim Dearing, an AAFP board member in a solo practice. Dr. Dearing hasn't yet invested in EMRs because of the lack of interoperability standards. He said he chose to join the project because he's barely making ends meet. He's already delivering high-quality care to some 25 patients a day, but he's still not efficient enough. Dr. Dearing said he hopes that TransforMED's advice and United's new reimbursement structure will help reinvigorate his practice.

The patient-centered medical home is a path into the future, he said in an interview. “If we don't try a product to make us better than where we are, we're not going to have a job.”

Under the UnitedHealthcare contract, participating physicians will receive a per member per month payment each quarter for the United members in their practice. The physicians also are eligible to receive a performance bonus retrospectively, based on whether they meet key quality measures.

Dr. Dearing is not without trepidation, however. “I'm scared to death about the costs,” he said, adding, “I'm scared to death about the implementation.”

“It's critically important that these pilots show positive outcomes so that the payment mechanisms can change,” Dr. McGeeney said. “There's too much soft data floating around out there now,” he said, adding that these UnitedHealthcare pilots should help provide some real proof of concept.

The Arizona demonstration runs for 3 years, and the Colorado and Rhode Island projects for 2 years, through 2011.

But Mr. Sullivan predicted that physicians, payers, and patients will know sooner, rather than later, about what works and what doesn't work with the projects.

UnitedHealth Group has decided to invest further in the medical home concept, despite a lack of demonstrated outcomes.

In 2009, the insurer will spend more than $1 million on “enhanced primary care payments,” said Eric Sullivan, national director of patient-centered medical home initiatives for the UnitedHealthcare unit.

The focus will be on projects in Colorado, Rhode Island and Arizona. Each project is slightly different. In Colorado, UnitedHealthcare is part of the Chronic Care Sustainability Initiative, a multi-payer demonstration project. UnitedHealthcare is joining with I.B.M. in Arizona in an extensive project that will involve the re-invention of the practices of 24 physicians. The Rhode Island project is being administered by the state insurance commissioner and is a collaboration with United, the state Medicaid plan and the state Blue Cross and Blue Shield plan, Mr. Sullivan said in an interview.

The insurer will be using “all three pilots to inform our decisions going forward in terms of how we support comprehensive primary care,” Mr. Sullivan said. Researchers at Harvard's School of Public Health will be studying the Colorado and Rhode Island initiatives and publicly reporting on them. UnitedHealthcare will join with internal and external consultants to study the Arizona project. The findings will be shared with I.B.M., the physicians involved, and medical societies in the state.

TransforMED, the for-profit division of the American Academy of Family Physicians, has been consulting with UnitedHealthcare on its demonstration projects. Dr. Terry McGeeney, president and chief executive officer of TransforMED, advised that a certain amount of transparency would be wise in these projects, given that there's “always a certain amount of distrust between physicians and payers.”

As an example, he cited a UnitedHealthcare demonstration project in Florida that never got off the ground because the “timing wasn't right. In the Florida market at that time, there was a lot of distrust around motives.” Based on the many meetings he observed, United's expectations were “too much [for physicians] to digest.”

In Arizona, UnitedHealthcare is collaborating with I.B.M., which has been active in advancing the medical home concept. Seven primary care practices were selected. Each had a large volume of United enrollees, met United's definition of a high-quality provider, and agreed to transform into a medical home for all of their patients, and not just United enrollees (Most I.B.M. employees are covered by United.)

The project only covers adult medicine, not pediatrics. The 24 physicians in the seven practices see 13,000-15,000 United enrollees, in commercial, Medicare and Medicaid plans, Mr. Sullivan explained.

UnitedHealthcare brought in—and paid for—TransforMED to help the practices retool into medical homes. The company will teach physicians how to change their practices, giving them advice and tools to enhance teamwork and more efficiently manage care, Dr. McGeeney said. The insurer will not be providing any direct funds for purchase of staff or electronic medical record hardware or software, he said. Most of the practices taking part in the demonstration already have or are purchasing EMR systems.

One of the Arizona project participants is Phoenix physician Jim Dearing, an AAFP board member in a solo practice. Dr. Dearing hasn't yet invested in EMRs because of the lack of interoperability standards. He said he chose to join the project because he's barely making ends meet. He's already delivering high-quality care to some 25 patients a day, but he's still not efficient enough. Dr. Dearing said he hopes that TransforMED's advice and United's new reimbursement structure will help reinvigorate his practice.

The patient-centered medical home is a path into the future, he said in an interview. “If we don't try a product to make us better than where we are, we're not going to have a job.”

Under the UnitedHealthcare contract, participating physicians will receive a per member per month payment each quarter for the United members in their practice. The physicians also are eligible to receive a performance bonus retrospectively, based on whether they meet key quality measures.

Dr. Dearing is not without trepidation, however. “I'm scared to death about the costs,” he said, adding, “I'm scared to death about the implementation.”

“It's critically important that these pilots show positive outcomes so that the payment mechanisms can change,” Dr. McGeeney said. “There's too much soft data floating around out there now,” he said, adding that these UnitedHealthcare pilots should help provide some real proof of concept.

The Arizona demonstration runs for 3 years, and the Colorado and Rhode Island projects for 2 years, through 2011.

But Mr. Sullivan predicted that physicians, payers, and patients will know sooner, rather than later, about what works and what doesn't work with the projects.