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Post by agedhippie on Apr 23, 2019 19:33:25 GMT -5
Kaiser are leaders in some areas and laggards in others. In endo they definitely lag. They do at least pay lip service to evidence based medicin, but they are also very cost driven and no companies look at costs over very long time scales. Many believe that Kaiser is non profit, but the medical provider part of their business is for profit. Interesting, "no companies look at costs over very long time scales." I'm not sure what you meant by that statement. Maybe that "very" is irrelevant. If your losing money after 5 years, you can extrapolate the data and conclude your going to be losing money after 8 years. Is that why you said "very", because there's no need to go back that far when you can conclude the same result with just a couple years? You are not going to see a significant difference in complications in a couple of years. Complications take ten years or so to even start to show up. Insurers expect to have you off their books long before then. Does KP want to be the altruistic insurer that treats people to reduce their competitors costs a decade later? This is the problem with the US system, there is no incentive for the middlemen to think of the long term.
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johny
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Post by johny on Apr 23, 2019 19:44:40 GMT -5
Interesting, "no companies look at costs over very long time scales." I'm not sure what you meant by that statement. Maybe that "very" is irrelevant. If your losing money after 5 years, you can extrapolate the data and conclude your going to be losing money after 8 years. Is that why you said "very", because there's no need to go back that far when you can conclude the same result with just a couple years? You are not going to see a significant difference in complications in a couple of years. Complications take ten years or so to even start to show up. Insurers expect to have you off their books long before then. Does KP want to be the altruistic insurer that treats people to reduce their competitors costs a decade later? This is the problem with the US system, there is no incentive for the middlemen to think of the long term. Big Age, what's going on man What kind of complications are we talking about here? Some complications reveal themselves quicker than others. The complications your talking about "take 10 years or so to show up", I guess were talking about medicinal side-effect complications.. In that case, I agree with you. But I was talking about making things "standard of care" for the better. It won't take 10 years to see the results diabetics get from Afrezza.
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Post by agedhippie on Apr 23, 2019 19:51:47 GMT -5
You are not going to see a significant difference in complications in a couple of years. Complications take ten years or so to even start to show up. Insurers expect to have you off their books long before then. Does KP want to be the altruistic insurer that treats people to reduce their competitors costs a decade later? This is the problem with the US system, there is no incentive for the middlemen to think of the long term. Big Age, what's going on man What kind of complications are we talking here? Some complications reveal themselves quicker than others. The complications your talking about "take 10 years or so to show up", I guess were talking about medicinal side-effect complications.. In that case, I agree with you. But I was talking about making things "standard of care" for the better. It won't take 10 years to see the results diabetics get from Afrezza. I was thinking more of the diabetic complications like neuropathy, retinopathy, that sort of thing. From onset they take about ten years typically, longer if you have reasonable control. The reason they may appear to have a quicker course is that for Type 2 initial diagnosis is often delayed by which time a lot of the damage has already been done and much of that ten years has been eaten up.
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johny
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Post by johny on Apr 23, 2019 20:08:44 GMT -5
Big Age, what's going on man What kind of complications are we talking here? Some complications reveal themselves quicker than others. The complications your talking about "take 10 years or so to show up", I guess were talking about medicinal side-effect complications.. In that case, I agree with you. But I was talking about making things "standard of care" for the better. It won't take 10 years to see the results diabetics get from Afrezza. I was thinking more of the diabetic complications like neuropathy, retinopathy, that sort of thing. From onset they take about ten years typically, longer if you have reasonable control. The reason they may appear to have a quicker course is that for Type 2 initial diagnosis is often delayed by which time a lot of the damage has already been done and much of that ten years has been eaten up. Ohh alright, the long term side-effects of diabetes. You said, "insurers expect to have you off their books long before then." That might be the case, but how would they "expect" that, if the reputation of their services is good, and the patient is compliant with the costs to keep their services, how would they expect that? I don't think they can expect it. I think they consider both, the short term and long term side effects when trying to make a difference for the better. The fact is, right now, they care for 65 year olds and up, who are diabetic. They are directly helping both age groups by improving present time "standards of care" for diabetics as a whole.
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Post by mango on Apr 23, 2019 21:13:57 GMT -5
Big Age, what's going on man What kind of complications are we talking here? Some complications reveal themselves quicker than others. The complications your talking about "take 10 years or so to show up", I guess were talking about medicinal side-effect complications.. In that case, I agree with you. But I was talking about making things "standard of care" for the better. It won't take 10 years to see the results diabetics get from Afrezza. I was thinking more of the diabetic complications like neuropathy, retinopathy, that sort of thing. From onset they take about ten years typically, longer if you have reasonable control. The reason they may appear to have a quicker course is that for Type 2 initial diagnosis is often delayed by which time a lot of the damage has already been done and much of that ten years has been eaten up. I wonder what percentage of the these diabetes-related conditions in the T2D population world-wide is a result of the incorrect and misleading medical term, "pre-diabetes"?
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Post by agedhippie on Apr 24, 2019 7:40:49 GMT -5
I was thinking more of the diabetic complications like neuropathy, retinopathy, that sort of thing. From onset they take about ten years typically, longer if you have reasonable control. The reason they may appear to have a quicker course is that for Type 2 initial diagnosis is often delayed by which time a lot of the damage has already been done and much of that ten years has been eaten up. Ohh alright, the long term side-effects of diabetes. You said, "insurers expect to have you off their books long before then." That might be the case, but how would they "expect" that, if the reputation of their services is good, and the patient is compliant with the costs to keep their services, how would they expect that? I don't think they can expect it. I think they consider both, the short term and long term side effects when trying to make a difference for the better. The fact is, right now, they care for 65 year olds and up, who are diabetic. They are directly helping both age groups by improving present time "standards of care" for diabetics as a whole. For the vast majority of patients their insurance is tied to their job and people stay with the same company on average just under five years. My last job used Cigna, this one uses Aetna. Does Cigna want to pay to reduce Aetna's costs? Not really so they stick to the cheapest solution that is SOC compliant. I am not sure who the 'they' is in your last sentence, but it's definitely not the insurers. They lag in any area that is going to increase their costs and that is not unreasonable since they are 'for profit' companies and their shareholders will kill them if their costs rise. Look at the fight over CGMs as an example.
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Post by agedhippie on Apr 24, 2019 7:42:30 GMT -5
I was thinking more of the diabetic complications like neuropathy, retinopathy, that sort of thing. From onset they take about ten years typically, longer if you have reasonable control. The reason they may appear to have a quicker course is that for Type 2 initial diagnosis is often delayed by which time a lot of the damage has already been done and much of that ten years has been eaten up. I wonder what percentage of the these diabetes-related conditions in the T2D population world-wide is a result of the incorrect and misleading medical term, "pre-diabetes"? I wouldn't argue with that. I think late diagnosis is the biggest driver of complications in T2. If this was dealt with earlier things would be a lot better.
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Deleted
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Post by Deleted on Apr 24, 2019 7:53:04 GMT -5
Interesting, "no companies look at costs over very long time scales." I'm not sure what you meant by that statement. Maybe that "very" is irrelevant. If your losing money after 5 years, you can extrapolate the data and conclude your going to be losing money after 8 years. Is that why you said "very", because there's no need to go back that far when you can conclude the same result with just a couple years? You are not going to see a significant difference in complications in a couple of years. Complications take ten years or so to even start to show up. Insurers expect to have you off their books long before then. Does KP want to be the altruistic insurer that treats people to reduce their competitors costs a decade later? This is the problem with the US system, there is no incentive for the middlemen to think of the long term. The incentive will be CGMs because once DEX launches the G7 in late 2020, CGM penetration into the diabetes market will skyrocket and don't think the current system won't be disrupted, its ripe for it. The current SOC, based on patient outcomes is poor. Amazon continues to drop prices and increase store count. They are masters of distribution and logistics and the cloud based AWS can handle all the uploaded data from CGMs. Fee for service today, fee for outcomes tomorrow.
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Post by ktim on Apr 24, 2019 16:26:05 GMT -5
Kaiser are leaders in some areas and laggards in others. In endo they definitely lag. They do at least pay lip service to evidence based medicin, but they are also very cost driven and no companies look at costs over very long time scales. Many believe that Kaiser is non profit, but the medical provider part of their business is for profit. Interesting, "no companies look at costs over very long time scales." I'm not sure what you meant by that statement. Maybe that "very" is irrelevant. If your losing money after 5 years, you can extrapolate the data and conclude your going to be losing money after 8 years. Is that why you said "very", because there's no need to go back that far when you can conclude the same result with just a couple years? KP is very cost driven, and they do look back to recent years to figure out better outcomes for both their business model, and patient outcomes. Here's a study below, that took years of information. They concluded that this new process (HEART) would work better and by implementing it, they would avoid unnecessary hospitalizations (cost savings) without increasing patients risk of heart damage. ------------------------------------------------------------------------------------------------------------------------------------------------ February 27, 2019Emergency physicians at Kaiser Permanente hospitals in Southern California reduced hospital admissions and cardiac stress testing by using new criteria to assess the level of risk patients with chest pain have for subsequent cardiac events. The study examined outcomes in 3 periods: May 2015 to May 2016 before HEART was established May 6, 2016 to June 3, 2016, during the transition to HEART June 2016 to June 2017 after HEART was implemented “By assessing patients who come into the emergency department using HEART— a measure of history, electrocardiogram (ECG), age, risk factors and troponin, a blood test that measures heart injury — we were able to avoid unnecessary hospitalizations and cardiac testing for many patients without increasing their risk of heart damage,” said Adam L. Sharp, MD, MSc, an emergency physician at the Kaiser Permanente Los Angeles Medical Center and a researcher with the Kaiser Permanente’s Department of Research & Evaluation in Southern California. ------------------------------------------------------------------------------------------------------------------------------------------------------ "They do at least pay lip service to evidence based medicine" Sounds like you've had a bad experience with Kaiser Permanente. “pay lip service” is to consent in one's words while dissenting in one's heart. I know were talking about KP as a whole, because every doctors different. Do you have an example of how KP as a whole, is paying lip service? (While KP supports an A1C of 7% (which is still within diabetic range) it is also embraced by the American Diabetes Association, which suggests an A1C of 7% for all nonpregnant adult diabetics.) The quicker patients get prescribed Afrezza (within Kaiser Permanente), and the quicker they realize how to use it, the quicker Afrezza be a standard of care (within Kaiser Permanente.) I didn't mean to analyze everything you wrote/said, but that's what I tend to do when I'm listening/reading. You wrote some good ideas one of my recent posts and I just thought I'd try and hear you out. It's been a long day. I'm exhausted. I'd understand if you feel the same way. I guess I'm saying, say what you wish, its alright with me. When a doctor is making a decision about which insulin to put a newly diagnosed patient on, the complications that should be avoided by tighter control are usually longer than 5 or 8 years out other than cases where someone has by choice or circumstance had really bad health care and isn't diagnosed until late in progression. I know a lot of people in healthcare management, including some Kaiser. I've discussed this with them. In private they will admit that there is little incentive to go out of their way looking for long term cost savings, which they can't even know would accrue to them since members often go to other providers or Medicare. Propagating one narrative and then privately admitting it's not entirely true is why I'd use the term "paying lip service". Though perhaps that is too harsh. All of them do it. From insurance advertising you'd think that the patient was all any of them consider and $$$ means nothing to them. I had Kaiser for a couple of years more than a decade ago and really liked them, but my medical needs were pretty simple. If you google about Kaiser you can find the whole "mixed bag" reputation they have. There are highly integrated and efficient... seamless referrals, integrated medical records, etc. But patients do complain about having to fight for access to certain therapies. They probably aren't significantly worse than other healthcare, but I do know that at Kaiser, unlike if your doctor doesn't work for the insurance company, the Kaiser doctors are monitored and corralled to stick to the status quo plan. I'm sure good doctors would push back on things they don't agree with but needing to push back is still a hindrance. More senior doctors can more easily change things, but they are likely a part of the problem being set in old ways. If one is fresh out of medical school and wanting lots of freedom to practice medicine in a patient focused experimental sort of way, Kaiser isn't where one should go. Kaiser has been a leader in certain areas. Kaiser was very progressive in developing HIV treatment regimes, and that likely wasn't about savings money. Wish they would do the same for diabetes, but if you don't believe me, do some googling and find out what Kaiser diabetes patients have to say about them. CGMs are hard to get. Older insulins are pushed instead of expensive RAAs. Kaiser does have unique potential if, like what happened with HIV, they had some visionary doctors get behind Afrezza. If something gets into their Kaiser standard of care, then the fact that they push doctors to adhere to it would be a benefit. If you hear of some Kaiser doctor actually promoting Afrezza for their patients that would be a great sign because that would be out of the ordinary for Kaiser and potentially a signal that doors are really opening there and could spread rapidly. I keep my ear to the ground as much as I can with people I know. Always on the lookout for signs of that inflection point.
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johny
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Post by johny on Apr 24, 2019 16:55:03 GMT -5
Ohh alright, the long term side-effects of diabetes. You said, "insurers expect to have you off their books long before then." That might be the case, but how would they "expect" that, if the reputation of their services is good, and the patient is compliant with the costs to keep their services, how would they expect that? I don't think they can expect it. I think they consider both, the short term and long term side effects when trying to make a difference for the better. The fact is, right now, they care for 65 year olds and up, who are diabetic. They are directly helping both age groups by improving present time "standards of care" for diabetics as a whole. For the vast majority of patients their insurance is tied to their job and people stay with the same company on average just under five years. My last job used Cigna, this one uses Aetna. Does Cigna want to pay to reduce Aetna's costs? Not really so they stick to the cheapest solution that is SOC compliant. I am not sure who the 'they' is in your last sentence, but it's definitely not the insurers. They lag in any area that is going to increase their costs and that is not unreasonable since they are 'for profit' companies and their shareholders will kill them if their costs rise. Look at the fight over CGMs as an example. Age, you said, "Insurers expect to have you off their books long before then." Due to people leaving their job, and finding another - I agree. People could be forced to switch insurers, when they change jobs. But the position they leave will get filled by another person. The people change, but the diseases they carry don't. Example, KP might lose a patient (due to employment reasons like you said), but they'll get another patient who could have been previously insured by Cipla. If, "Insurers expect to have you off their books long before then." then they expect that person to be replaced with another person. Insurers have no control over who the employer hires. Your whole point was based on long term side effects, and how KP doesn't want to go out of their way to help better the quality of life for diabetics who are currently under their insurance plan, because they don't want to decrease the costs for their competitor in the future. HUH. The scenario was, KP is monitoring patients who are taking Afrezza, trying to see if it's possible for them to get a better outcome than what their current SOC recommends. With this scenario (directly above) there isn't much to breakdown, it is what it is, and it is happening.
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Post by agedhippie on Apr 24, 2019 17:41:14 GMT -5
For the vast majority of patients their insurance is tied to their job and people stay with the same company on average just under five years. My last job used Cigna, this one uses Aetna. Does Cigna want to pay to reduce Aetna's costs? Not really so they stick to the cheapest solution that is SOC compliant. I am not sure who the 'they' is in your last sentence, but it's definitely not the insurers. They lag in any area that is going to increase their costs and that is not unreasonable since they are 'for profit' companies and their shareholders will kill them if their costs rise. Look at the fight over CGMs as an example. Age, you said, "Insurers expect to have you off their books long before then." Due to people leaving their job, and finding another - I agree. People could be forced to switch insurers, when they change jobs. But the position they leave will get filled by another person. The people change, but the diseases they carry don't. Example, KP might lose a patient (due to employment reasons like you said), but they'll get another patient who could have been previously insured by Cipla. If, "Insurers expect to have you off their books long before then." then they expect that person to be replaced with another person. Insurers have no control over who the employer hires. Your whole point was based on long term side effects, and how KP doesn't want to go out of their way to help better the quality of life for diabetics who are currently under their insurance plan, because they don't want to decrease the costs for their competitor in the future. HUH. The scenario was, KP is monitoring patients who are taking Afrezza, trying to see if it's possible for them to get a better outcome than what their current SOC recommends. With this scenario (directly above) there isn't much to breakdown, it is what it is, and it is happening. I think your reply splits into two parts; the percentage of diabetics in an insurer's pool will not vary significantly, and that this doesn't matter anyway since KP are monitoring patients to evaluate outcomes. The first part does not alter the fact that there is little incentive or an insurer to start insulin early or incur extra costs. They could take excellent care of their diabetics and hand them on to the next insurer in great shape, but there is a financial cost to that. The problem comes when some other insurer decides to spend the bare minimum and hands over their diabetic to the good insurer insurer in poor shape. The good guys lay out the money but don't reap the savings, the bad guys don't spend money but reap the savings from the good guys actions. All through this the number of diabetics in the pool is constant. The second part definitely applies if all KP are doing is evaluating Afrezza. The key thing there is going to be the protocol they use as we saw with the phase 3 trial vs. STAT - a bad protocol produces a bad result.
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Post by ktim on Apr 24, 2019 17:51:59 GMT -5
johny You said "The scenario was, KP is monitoring patients who are taking Afrezza, trying to see if it's possible for them to get a better outcome than what their current SOC recommends." If this is true that Kaiser is taking a serious look at Afrezza, it is great. I haven't seen any evidence of this. Getting put on tier 4 or 5 (whatever that is) on a formulary isn't an indication they are taking a serious look at it. It could just mean that they're making it slightly easier for patients who absolutely demand it. Would love evidence they actually are doing as you say. Change does occur within Kaiser like that. Some doctor that really wants to try out new therapy gets approval from the committees to do "mini study" outside of their normal SOC. Sadly what I see, at least of my regional Kaiser, is that their endo department seems particularly stuck in old ways. As for health care financial incentives it gets extremely complicated. In the long run the whole system has incentive to run health care costs up, not down, as they basically are getting a percentage of all costs as profits. Even in the short term there are some perverse incentives that come into play such as "rebates" actually encouraging PBM managers to play along, or encourage, drug price increases. Sadly it seems the cumulative effect of the way the system is set up is to ignore ballooning costs in the long run (I'll avoid being so cynical as to say they encourage it) and provide non-inferior outcomes in the short term while penny pinching to have slightly better margins than your competitors. Long term patient well being certainly isn't the primary driver of decisions.
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johny
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Post by johny on Apr 24, 2019 18:05:25 GMT -5
Interesting, "no companies look at costs over very long time scales." I'm not sure what you meant by that statement. Maybe that "very" is irrelevant. If your losing money after 5 years, you can extrapolate the data and conclude your going to be losing money after 8 years. Is that why you said "very", because there's no need to go back that far when you can conclude the same result with just a couple years? KP is very cost driven, and they do look back to recent years to figure out better outcomes for both their business model, and patient outcomes. Here's a study below, that took years of information. They concluded that this new process (HEART) would work better and by implementing it, they would avoid unnecessary hospitalizations (cost savings) without increasing patients risk of heart damage. ------------------------------------------------------------------------------------------------------------------------------------------------ February 27, 2019Emergency physicians at Kaiser Permanente hospitals in Southern California reduced hospital admissions and cardiac stress testing by using new criteria to assess the level of risk patients with chest pain have for subsequent cardiac events. The study examined outcomes in 3 periods: May 2015 to May 2016 before HEART was established May 6, 2016 to June 3, 2016, during the transition to HEART June 2016 to June 2017 after HEART was implemented “By assessing patients who come into the emergency department using HEART— a measure of history, electrocardiogram (ECG), age, risk factors and troponin, a blood test that measures heart injury — we were able to avoid unnecessary hospitalizations and cardiac testing for many patients without increasing their risk of heart damage,” said Adam L. Sharp, MD, MSc, an emergency physician at the Kaiser Permanente Los Angeles Medical Center and a researcher with the Kaiser Permanente’s Department of Research & Evaluation in Southern California. ------------------------------------------------------------------------------------------------------------------------------------------------------ "They do at least pay lip service to evidence based medicine" Sounds like you've had a bad experience with Kaiser Permanente. “pay lip service” is to consent in one's words while dissenting in one's heart. I know were talking about KP as a whole, because every doctors different. Do you have an example of how KP as a whole, is paying lip service? (While KP supports an A1C of 7% (which is still within diabetic range) it is also embraced by the American Diabetes Association, which suggests an A1C of 7% for all nonpregnant adult diabetics.) The quicker patients get prescribed Afrezza (within Kaiser Permanente), and the quicker they realize how to use it, the quicker Afrezza be a standard of care (within Kaiser Permanente.) I didn't mean to analyze everything you wrote/said, but that's what I tend to do when I'm listening/reading. You wrote some good ideas one of my recent posts and I just thought I'd try and hear you out. It's been a long day. I'm exhausted. I'd understand if you feel the same way. I guess I'm saying, say what you wish, its alright with me. When a doctor is making a decision about which insulin to put a newly diagnosed patient on, the complications that should be avoided by tighter control are usually longer than 5 or 8 years out other than cases where someone has by choice or circumstance had really bad health care and isn't diagnosed until late in progression. I know a lot of people in healthcare management, including some Kaiser. I've discussed this with them. In private they will admit that there is little incentive to go out of their way looking for long term cost savings, which they can't even know would accrue to them since members often go to other providers or Medicare. Propagating one narrative and then privately admitting it's not entirely true is why I'd use the term "paying lip service". Though perhaps that is too harsh. All of them do it. From insurance advertising you'd think that the patient was all any of them consider and $$$ means nothing to them. I had Kaiser for a couple of years more than a decade ago and really liked them, but my medical needs were pretty simple. If you google about Kaiser you can find the whole "mixed bag" reputation they have. There are highly integrated and efficient... seamless referrals, integrated medical records, etc. But patients do complain about having to fight for access to certain therapies. They probably aren't significantly worse than other healthcare, but I do know that at Kaiser, unlike if your doctor doesn't work for the insurance company, the Kaiser doctors are monitored and corralled to stick to the status quo plan. I'm sure good doctors would push back on things they don't agree with but needing to push back is still a hindrance. More senior doctors can more easily change things, but they are likely a part of the problem being set in old ways. If one is fresh out of medical school and wanting lots of freedom to practice medicine in a patient focused experimental sort of way, Kaiser isn't where one should go. Kaiser has been a leader in certain areas. Kaiser was very progressive in developing HIV treatment regimes, and that likely wasn't about savings money. Wish they would do the same for diabetes, but if you don't believe me, do some googling and find out what Kaiser diabetes patients have to say about them. CGMs are hard to get. Older insulins are pushed instead of expensive RAAs. Kaiser does have unique potential if, like what happened with HIV, they had some visionary doctors get behind Afrezza. If something gets into their Kaiser standard of care, then the fact that they push doctors to adhere to it would be a benefit. If you hear of some Kaiser doctor actually promoting Afrezza for their patients that would be a great sign because that would be out of the ordinary for Kaiser and potentially a signal that doors are really opening there and could spread rapidly. I keep my ear to the ground as much as I can with people I know. Always on the lookout for signs of that inflection point. The fact is, the current SOC in all of healthcare isn't working. This is obvious when you look at insurers diabetes goals. 7% is still in diabetes range, its still harming the body. Not only is the health care system screwed up, but organizations like the ADA, who support 7%, are as well. The whole worlds perspective of how to manage diabetes is a mess. Sure you have people who manage their diets to a T and are able to get better results than most, but were talking about the majority who aren't managing to a T. Things are a mess because there's never been a solution for better outcomes. We've been deprived of innovations pertaining to diabetes for so long that healthcare has had no choice, but to settle for what's currently available. It doesn't take a genius to know, that if your able to control your diabetes in the your early years, your more likely to avoid the serious outcomes of diabetes in your later years. All doctors know this. They just don't know how to get there with what's currently available to them. Right now, Kaiser Permanente is testing out Afrezza, and if its proven to bring a greater outcome, Kaiser Permanente will change its rusted gears and move towards Afrezza. "In private they will admit that there is little incentive to go out of their way looking for long term cost savings, which they can't even know would accrue to them since members often go to other providers or Medicare." What does KP giving Afrezza a chance, have to do with healthcare folks admitting that there is little incentive to go out of their way looking for long term cost savings? I appreciate the response.
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johny
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Post by johny on Apr 24, 2019 18:22:21 GMT -5
Age, you said, "Insurers expect to have you off their books long before then." Due to people leaving their job, and finding another - I agree. People could be forced to switch insurers, when they change jobs. But the position they leave will get filled by another person. The people change, but the diseases they carry don't. Example, KP might lose a patient (due to employment reasons like you said), but they'll get another patient who could have been previously insured by Cipla. If, "Insurers expect to have you off their books long before then." then they expect that person to be replaced with another person. Insurers have no control over who the employer hires. Your whole point was based on long term side effects, and how KP doesn't want to go out of their way to help better the quality of life for diabetics who are currently under their insurance plan, because they don't want to decrease the costs for their competitor in the future. HUH. The scenario was, KP is monitoring patients who are taking Afrezza, trying to see if it's possible for them to get a better outcome than what their current SOC recommends. With this scenario (directly above) there isn't much to breakdown, it is what it is, and it is happening. I think your reply splits into two parts; the percentage of diabetics in an insurer's pool will not vary significantly, and that this doesn't matter anyway since KP are monitoring patients to evaluate outcomes. The first part does not alter the fact that there is little incentive or an insurer to start insulin early or incur extra costs. They could take excellent care of their diabetics and hand them on to the next insurer in great shape, but there is a financial cost to that. The problem comes when some other insurer decides to spend the bare minimum and hands over their diabetic to the good insurer insurer in poor shape. The good guys lay out the money but don't reap the savings, the bad guys don't spend money but reap the savings from the good guys actions. All through this the number of diabetics in the pool is constant. The second part definitely applies if all KP are doing is evaluating Afrezza. The key thing there is going to be the protocol they use as we saw with the phase 3 trial vs. STAT - a bad protocol produces a bad result. Age, "The problem comes when some other insurer decides to spend the bare minimum and hands over their diabetic to the good insurer insurer in poor shape. The good guys lay out the money but don't reap the savings, the bad guys don't spend money but reap the savings from the good guys actions. All through this the number of diabetics in the pool is constant." Ah, I see, hopefully better therapies like Afrezza will eventually make everyone cough up the dough. We'll see. "The second part definitely applies if all KP are doing is evaluating Afrezza. The key thing there is going to be the protocol they use as we saw with the phase 3 trial vs. STAT - a bad protocol produces a bad result." You are right. This makes me want to email Mike. To remind him that KP could screw this up, if we stand idle while expecting the best. Thanks for simplifying things for me Age.
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Post by ktim on Apr 24, 2019 18:46:02 GMT -5
I think your reply splits into two parts; the percentage of diabetics in an insurer's pool will not vary significantly, and that this doesn't matter anyway since KP are monitoring patients to evaluate outcomes. The first part does not alter the fact that there is little incentive or an insurer to start insulin early or incur extra costs. They could take excellent care of their diabetics and hand them on to the next insurer in great shape, but there is a financial cost to that. The problem comes when some other insurer decides to spend the bare minimum and hands over their diabetic to the good insurer insurer in poor shape. The good guys lay out the money but don't reap the savings, the bad guys don't spend money but reap the savings from the good guys actions. All through this the number of diabetics in the pool is constant. The second part definitely applies if all KP are doing is evaluating Afrezza. The key thing there is going to be the protocol they use as we saw with the phase 3 trial vs. STAT - a bad protocol produces a bad result. Age, "The problem comes when some other insurer decides to spend the bare minimum and hands over their diabetic to the good insurer insurer in poor shape. The good guys lay out the money but don't reap the savings, the bad guys don't spend money but reap the savings from the good guys actions. All through this the number of diabetics in the pool is constant." Ah, I see, hopefully better therapies like Afrezza will eventually make everyone cough up the dough. We'll see. "The second part definitely applies if all KP are doing is evaluating Afrezza. The key thing there is going to be the protocol they use as we saw with the phase 3 trial vs. STAT - a bad protocol produces a bad result." You are right. This makes me want to email Mike. To remind him that KP could screw this up, if we stand idle while expecting the best.
Thanks for simplifying things for me Age. Something about Mike's wording when talking about Kaiser left the impression in my mind that he wanted to cleverly leave room for listeners to hear more than was there. I think the addition of Afrezza at the worst end of the formulary range could simply be Kaiser reaching the point where they are getting some new to membership that are already on Afrezza and would be very upset if forced off of it. If you email Mike, ask him if Kaiser really has a program to evaluate Afrezza. Is this really being looked at by the committees that make decisions about drug formularies and internal SOC guidelines. If he says yes, great. I wouldn't hold my breath on that, however. As big as Kaiser is where I live, I would suspect I might catch wind of any real evaluation, given I do a lot of inquiring whenever opportunity arises. Though I may not know until Afrezza gets moved to a preferred formulary tier at Kaiser. That would be share price moving news if/when it occurs, I'd imagine.
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