This study, supported by the National Institute on Drug Abuse (NIDA) and published in the Archives of General Psychiatry, found that individuals attaining high levels of an anti-cocaine antibody had significantly more cocaine free urine samples than those with lower antibody levels or those taking a placebo.  Unlike the antibodies produced by other vaccines, which destroy or disable the disease-causing agent, the cocaine antibodies prevent the drug from passing through the blood brain barrier to inhibit the drugs euphoric effects.   The study found that the proportion of subjects having a 50 percent reduction in use was significantly greater in those attaining higher antibody levels than those with lower levels.  However, only 38 percent vaccinated subjects attained the high antibody levels and significant effects of the vaccine only lasted 2 months.

Martell, B. A., Orson, F. M., Poling, J. et al. (2009). Cocaine vaccine for the treatment of cocaine dependence in methadone-maintained patients. Archives of General Psychiatry, 66(10), 1116-1123. http://archpsyc.ama-assn.org/cgi/content/abstract/66/10/1116

Authors: Bridget A. Martell, Frank M. Orson, James Poling, Ellen Mitchell, Roger D. Rossen, Tracie Gardner, Thomas R. Kosten.

This article, published in the New England Journal of Medicine (NEJM), considers the complexities surrounding linking provider payments and quality of care and health outcomes, noting that, among other issues,  reimbursement must be adjusted for patients' coexisting conditions to prevent hospitals for treating only low-risk patients to achieve high quality ratings. 

Wang, C. J., Conroy, K. N., Zuckerman, B. (2009). Payment reform for safety-net institutions—improving quality and outcomes. NEJM, 361(19), 1821-1823.

*Note: The New England Journal of Medicine (NEJM) policies preclude us from providing an article abstract or linking to the NEJM website; however, this article is available in full via the NEJM website. 

Authors: C. Jason Wang, Kathleen N. Conroy, Barry Zuckerman.

This New England Journal of Medicine (NEJM) article presents highlights from a September 14, 2009 roundtable on ways to health care cost growth, their effects on medical practice, and their likelihood to be included in national health care reform. 

Gawande, A. A., Fisher, E. S., Gruber J. et al. (2009). Perspective roundtable: the cost of health care — highlights from a discussion about economics and reform. NEJM, 361(15), 1421-1423.

*Note: The New England Journal of Medicine (NEJM) policies preclude us from providing an article abstract or linking to the NEJM website; however, this article is available in full via the NEJM website. 

Authors: Atul A. Gawande, Elliott S. Fisher, Jonathan Gruber, Meredith B. Rosenthal.

This New England Journal of Medicine Article examines cost-controlling measures focused on improving patient care for those needing the most costly services. 

Bodenheimer, T. & Berry-Millett, R. (2009). Follow the money — controlling expenditures by improving care for patients needing costly services. NEJM, 361(16), 1521-1523. DOI: 10.1056/NEJMp0907185

*Note: The New England Journal of Medicine (NEJM) policies preclude us from providing an article abstract or linking to the NEJM website; however, this article is available in full via the NEJM website. 

Authors: Thomas Bodenheimer, Rachel Berry-Millett.

The Center for Health Care Strategies (CHCS) has published a toolkit for behavioral health stakeholders interested in creative treatments for children and youth.  The toolkit includes the improved outcomes from the initiatives implemented by participating Managed Care Organizations (MCOs).

From the report:

Youth with serious emotional disorders are a high-utilizing and high-cost Medicaid population that is not well served by traditional approaches to care. Managed care organizations (MCOs) are uniquely positioned to deliver more appropriate and cost-effective care that addresses the complex needs of these children and young adults.

The Collaborative on Improving Managed Care Quality for Youth with Serious Behavioral Health Needs, an initiative designed by CHCS and made possible by the Annie E. Casey Foundation, worked with nine health plans to test a number of approaches to better serve this population. This toolkit, which summarizes the participating plans' experiences, presents:

• Promising practices implemented by the plans, and the resulting impact on access, care, and avoidance of unnecessary services and costs;
• Challenges identified and addressed by the plans, and lessons learned; and
• Opportunities for continued innovations in care for children and youth with serious behavioral health needs.

The toolkit is a valuable resource for MCOs, policymakers, state agencies, families, and others interested in innovative approaches to improve behavioral health care for youth.

Center for Health Care Strategies (CHCS). (2009). Improving Medicaid managed care for youth with serious behavioral health needs: a quality improvement toolkit. Allen, Kamala D., Pires, Sheila A., & Chazin, Stacey, ed.

Full report: http://www.chcs.org/publications3960/publications_show.htm?doc_id=1028618

This Kaiser Family Foundation report examines the impact of Massachusetts' 2006 health care reform law with special focus on affordability and accessibility of care. 

From the report:

The following key findings emerged from the research:

Public programs have increased access and provided affordable insurance coverage options for low-income individuals. The expansion of the Massachusetts Medicaid program and the creation of Commonwealth Care, a program that subsidizes coverage for adults under 300% FPL, have reduced the uninsured rate for lowincome residents and allowed many people to gain access to affordable coverage and obtain care.  However, some people are still struggling to afford coverage and care. Low-income workers with access to employer-sponsored coverage, as well as moderate-income individuals without access to employersponsored coverage, are both ineligible for state subsidized insurance. Coverage options for these individuals often remain unaffordable.  People with chronic conditions still face greater cost barriers to care. While nominal co-payments may be affordable for people who need care only occasionally, lower-income people who need ongoing care may quickly find the out-of-pocket costs unaffordable.  System complexities can lead to gaps in coverage. With the multitude of programs offered by Massachusetts, all with varying eligibility and programmatic rules, residents with fluctuating incomes and employment statuses can fall through the cracks. These individuals, and others who are ineligible for existing programs, still rely on a health safety net program to obtain services and aid in paying for needed care.  Fear of incurring unaffordable medical bills and medical debt remains a barrier to accessing needed health care. Unaffordable medical bills and pre-existing medical debt still create anxiety and cause many to delay or forgo needed services. 

These findings provide important lessons with respect to national health reform. Public programs can serve as an important foundation for health reform that can provide low-income individuals access to consistent, continuous and affordable care. The quality of employer-sponsored coverage, in terms of the comprehensiveness of the benefits and the affordability of coverage, matters for individuals with this coverage, especially for those chronic conditions or other significant health care needs. A health safety net is necessary for people who are not covered under public or private programs, for those who are underinsured, and for those who are between programs and coverage. Lastly, ongoing monitoring of access and affordability will be important to understand how the cost of insurance affects families’ ability to access care. 

Kaiser Family Foundation. (2009). Consumers' experience in Massachusetts: lessons for national health reform. Carol Pryor and Andrew Cohen, Access Project.

Full report: http://www.kff.org/healthreform/upload/7976.pdf