Perverse Financial Incentives Driving Atypical Use and Medicaid Costs

1. Perverse Financial Incentives Driving Atypical Use and Medicaid Costs Ed Knight, PhD, CPRP Co-Investigator UCLA Health Sciences Service Research Center

2. Atypical Side Effects are the Highest Medicaid Cost • 1) Medicaid and medicare costs are out of control. • 2) The largest costs are safely preventable and will save lives. • 3) The largest and fastest growing costs are the co-occurring medical costs connected to mental health services. Much from off label use which the FDA does NOT approve. DrSederer has done an excellent job of documenting this. • 4) Off label use of anti psychotic medications for things like sleep and anxiety causes diabetes, obesity, high blood pressure and high cholesterol. This is wide spread.

3. Less Toxic or Non Toxic Products Not Eliminated • 5) Most often clinically tested non-toxic alternatives are not used or even mentioned. Things like CBT for anxiety, behavior interventions for anxiety. Acceptance and Commitment Therapy for anxiety. Nor are less toxic medications often offered. NOR ARE PATIENTS TOLD OF THE LIFE THREATENING SIDE EFFECTS of atypical or other antipsychotics.

4. Charge to prescribe Charge to Manage Disease caused • 6) Many providers, hospitals, managed care companies then charge disease management costs in addition to the prescribing. In other words what diseases they caused by these off label prescriptions are being billed for and profits made.

5. Perverse Financial Incentive • 7) This payment for managing disease on top of off label use is a perverse financial incentive to cause disease to make money managing it.

6. Multiple anti psychotics. • 8) Many people are on multiple antipsychotics. Each additional one added does not increase any beneficial effects but does increase obesity, diabetes, high cholesterol. This also results in billing and profits to manage the diseases caused this way. This is a perverse financial incentive to cause disease also. • There is no profit in taking people off one drug before putting on another. • As a matter of fact good care costs money. • What are we paying for? Not who is profiting!!! • What are likely savings. VA high ranking Doctors tell me they save 30% per patient by controlling atypical uses.

7. Stop companies from making money by causing disease • 9) STOP THIS NOW!!! Make any medical business responsible for the costs of disease management for the diseases they cause. STOP THE MEDICAID RIP OFF OF DOUBLE COLLECTING FOR DISEASES THEY CAUSE. • Make Sure these incentives are NOT in your rfp. • All companies or their partners make money this way. • I WILL CONSULT ON THESE ISSUES IF YOU LIKE

8. What to do • Ethical Medicaid Medicare Cost • Savings will Save Lives TOO. • Please call your Senator or Representative • Capitol Switchboard • 202-224-3121 • Ask for your Senator or Representative by name • Find their emails at • www.congress.org • enter your zip code

9. Web Stuff • See blogs Perverse Financial Incentives Driving Medicaid Costs and Disease • lets-fix-perverse-financial-incentives.html • Contact Ed Knight for further information mailto:shamskayum@gmail.com