Aetna, CVS and data thoughts

CVS has agreed to buy Aetna for a lot of money. This raises a lot of questions including, what is the value proposition?

There is the obvious value proposition that CVS has 10,000 physical locations on the same information platform. I am spitballing and harkening back to my days as an insurance data geek and there are three inter-related items that could generate an incredible amount of revenue for the Aetna/insurance side of the deal. This is a risk adjustment data gold mine.
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Actions Have Consequences: Lysistrata Edition

I’ll just leave this here for your schadenfreude and viewing pleasure. Albo is quitting the Virginia House of Delegates.



Evidence based care in Medicaid

We want to do evidence based care.  We want to do things that work and avoid things that don’t work.  This sounds simple.  Let’s look at two very good natural experiments on unintended pregnancy rates:

Colorado:

    Since 2008, Colorado has successfully increased access to family planning services throughout the state, particularly for the most effective contraceptive methods, such as intrauterine devices (IUDs) and implants.

  • The Colorado Family Planning Initiative has increased health care provider education and training and reduced costs for more expensive contraceptive options, enabling more than 30,000 women in the state to choose long-acting reversible contraception….
  • When contraception, particularly the long-acting methods, became more readily available in Colorado between 2009 and 2013, the abortion rate fell 42 percent among all women ages 15 to 19 and 18 percent among women ages 20 to 24.
  • Colorado is a national leader in the use of long-acting reversible contraception, and reducing teen pregnancy and repeat pregnancies.

    • Teen birth rates in our state have declined more rapidly than in any other state or the nation as a whole.
  • The birth rate for Medicaid-eligible women ages 15 to 24 dropped sharply from 2010 to 2012, resulting in an estimated $49 million to $111 million avoided expenses in Medicaid birth-related costs alone.

More reliable and effective contraception was made available to Colorado women who had the choice to elect Long Acting Reverisble Contraception (LARC) or do something else.  A significant number of women elected to use LARC and the increased autonomy and reliability produced amazingly good results.

Texas

 

Reducing contraceptive availability led to higher abortion rates and higher unplanned pregnancies. Earlier live births have massively negative multi-generational repercussions for both the parents and kids.

The evidence strong suggests that significant improvements in quality of life can be made and significant expenditures reduced if contraception is made readily available.

And guess what Congress will consider to be a high priority:

House Speaker Paul Ryan announced Thursday that Republicans will move to strip all federal funding for Planned Parenthood as part of the process they are using early this year to dismantle Obamacare.

Wahoo… the evidence will strongly support the hypothesis that this policy will lead to more unintended pregnancies, more abortions and far worse outcomes for far more Americans.

Evidence based policy making — Hoo Yaa



Why we can’t have success

The kids these days…

They’re more than alright… they, as a cohort, engage in far less dumb, risk seeking behavior than my cohort did at the same point in my life.

There are two major components of the decline. The first is that kids these days are far less stupid and idiotic and risk taking thrill seekers compared to twenty years ago. This would be Kevin Drum’s Lead hypothesis. As teenagers grow up with far lower exposures to known neurotoxins that impede judgement and encourage short term gratification, they use more judgement and think about the future a little more. They’re still teenagers but they are not stupid. Compared to my teen years, teens are having less sex. However over the past nine years, the amount of sex teens are having is fairly constant.

The other major component of the decline is far more frequent and effective contraception use. Guttmacher found that the entire decline in pregnancy rates among teens was the uptake in effective birth control utilization:

Sexual activity in the last 3 months did not change significantly from 2007 to 2012. Pregnancy risk declined among sexually active adolescent women (p = .046), with significant increases in the use of any method (78%–86%, p = .046) and multiple methods (26%–37%, p = .046). Use of highly effective methods increased significantly from 2007 to 2009 (38%–51%, p = .010). Overall, the PRI declined at an annual rate of 5.6% (p = .071) from 2007 to 2012 and correlated with birth and pregnancy rate declines. Decomposition estimated that this decline was entirely attributable to improvements in contraceptive use.

So the question going forward is whether or not we’ll see those trend lines break?

I think we will. The Federal government will go all in again on ineffective abstinence based misinformation. Essential health benefits will be redefined to exclude most highly effective birth control methods (oral hormones, IUDs, implants etc). Awareness of what works will decrease while access will decline. If we hold the amount of sex being had constant, that means more pregnancies.

I also predict that the older teens will see a lower bounce in their age adjusted pregnancy risk than younger teens. Older teens have some money, they have some knowledge of how to work the system and most importantly, the women who know that they are at high risk of unplanned pregnancy have had the ability to get long acting and reversible contraception (IUDs) to control their risk and maintain their autonomy. Younger teens in the Trump administration won’t have those advantages. I expect births to mothers under the age of 15 to increase at a higher rate than births to mothers at age 18.



Zika and abortions

Scientific America has some bad news about Zika in Puerto Rico:

“Based on the limited available information on the risk of microcephaly, we estimate between 100 to 270 cases of microcephaly might occur” between mid-2016 and mid-2017, said Dr. Margaret Honein, chief of the birth defects branch at the CDC, who was one of several authors of the study published August 19 in JAMA Pediatrics.

Politico’s Jennifer Haberkorn looks at how Zika could change the discssion on abortion:

Pregnant women with the Zika virus are at risk of giving birth to babies with devastating brain damage, which can be detected only around 18 to 20 weeks — and often much later than that. …

An Aug. 5 Harvard University-STAT poll found only 23 percent of American adults believe a woman should have access to abortion after 24 weeks of pregnancy. But that opposition softened notably when the question was framed in terms of Zika.

“Maybe the Zika epidemic and its implications for pregnant women will help us shine a light on the exactly tragic situation in which you have these abortions,” said Rep. Diana DeGette (D-Colo.), co-chairman of the House Pro-Choice Caucus.

Life and decision making gets a lot simpler when we assume that women are capable moral agents making their own decisions about their own health and autonomy.  But our political process does not allow for that.  The Politico article brings up the rubella epidemic that led to abortion being discussed in public as “respectable” discussion as it was seen as a health procedure instead of an non-punishment for the sluts (you know those girls) for having sex.

Dr. Jen Grunter writes about how she came to perform abortions during later stages of pregnancies.  Her patients needed help and she helped them.

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Late Night Horrorshow: Zika Is Coming, Ready or Not

I’m probably gonna get dinged for chicken-littling, because hey, no Ebola outbreak happened in America, right? And yet… “White House Ebola response coordinator from 2014 to 2015” Klain’s Washington Post article:

The good news is that both the House and Senate have finally passed bills that would provide some funding to combat the Zika virus. The bad news is that this action comes more than three months after President Obama requested the aid. Moreover, the House bill provides only one-third of the response needed; pays for this limited, ineffective response by diverting money allocated to fight other infectious diseases; and necessitates a conference committee to resolve differences with the Senate bill, meaning we still do not know when any money will finally get through Congress to fund the response…

As befuddling as Congress’ refusal to approve funds for the Zika response is, perhaps even more of a mystery is why such approval is needed in the first place. If nature was threatening us with serious injury and evacuations via fire, flood or hurricane, the president could use his authority under the Stafford Disaster Relief and Emergency Assistance Act to provide immediate aid without waiting for Congress to act. The fact that epidemic “natural disasters” are the result of disease and not an earthquake or tornado should not constrain the federal government’s ability to provide a timely, comprehensive response…

Speaking of those damaged babies? Once the Zika virus gets established in “our” mosquitos, microcephaly is going to become yet another standard prenatal test for women in the afflicted areas. Or who’ve visited those areas. Or whose male partners were exposed to Zika, even months before the pregnancy. And by the time microcephaly can be diagnosed, it’s too late for a quiet ‘medical abortion‘ — women will need full surgical services, and most will have been visibly pregnant. It’s not going to be easy for ‘fundamentalist’ anti-choicers to find reasons to blame good married Christian white ladies in the Sunbelt for having been bitten by the wrong mosquito… but I’m sure they’re gonna try their damndest.
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If Not the Best, Then Certainly the Most Pleasurable Response to the November Terrorist Attacks in Paris

The Guardian has reported that when Brussels went into lockdown immediately after the Paris terrorist attacks the Belgian security response was, shall we say, innovative. A number of soldiers and police working out of a station in Ganshoren had an orgy! This gives new meaning to both the concept of a full body search and security theater, if you know what I mean… This seems to be a far superior response than to freak out on cable news 24/7, but your mileage may vary.