Schizophrenia, a devastating mental illness that affects nearly 2.2 million Americans, is associated with high rates of morbidity and mortality.1 Persons with schizophrenia have a 20% shorter life expectancy than the general population.1,2 Furthermore, among persons with schizophrenia, there is an increased prevalence of metabolic syndrome characterized by a constellation of risk factors, including insulin resistance, abdominal obesity, dyslipidemia, hyperglycemia, and hypertension,3
As publicly funded health care payment programs have grown over decades because of demographic shifts and expansion of coverage, comparative effectiveness research (CER) has emerged to address value in health care. The American Recovery and Reinvestment Act of 2008 (ARRA) included $1.1 billion for CER initiatives, and the new health care legislation created the Patient-Centered Outcomes Research Institute, which will be funded with $500 million or more annually. In these efforts exist the promise to create informed decisions that will improve health care at both the individual and population levels.
In the United States, it has been estimated that 7.8% of the total population has diabetes. In 2007, the direct medical expenditures for diabetes were about $116 billion and the total direct and indirect costs were $174 billion, according to the CDC.1
Medication adherence increased in patients who received a 90-day supply compared with those who received a 30-day supply,
according to a recent presentation at the Academy of Managed Care Pharmacy’s Annual Meeting.
The recent signing of health reform legislation signals a watershed event in the delivery of health care in our country. It is the culmination of a tangled legislative battle, but it ignores 3 of the 4 pillars of health reform. In this article, I describe these pillars, and then outline how recent legislation falls short.