Managed Care
Disease
Management
ACO Update
Peter Wehrwein
Hospital-led ACOs may have some advantages in the beginning, but the physician group ACOs may win out in the long run. That said, there’s plenty of room in the ACO-sphere for both models to prosper, especially as hospitals change into organizations that no longer live and die by the filled bed.
Joseph Burns

Brenda Motheral, RPh, MBA, PhD

In 1914, Henry Ford nearly doubled his workers’ pay to $5 a day, guaranteeing a whole new market for his cars. Cars aren’t drugs, and health plans are faced with the problem of how to give access to miracle medications without bankrupting patients with out-of-pocket costs.
Cover Story
Joseph Burns
The $1,000 pill a patient takes today for hepatitis C will hopefully prevent the $580,000 liver transplant down the road. It’s not a matter of simple math, however, and weighing the cost and benefit can be frustrating. For one thing, there’s the issue of patient churn.
News & Commentary
It can’t be described as a woman’s disease any longer, thanks to a projected 10-fold increase in the number of men over 60 from 1950 to 2050. “Hip fractures in men are associated with greater mortality compared to women, with rates as high as 37% in the first year following fracture,” according to a study by the International Osteoporosis Foundation.
The Formulary Files
Krishna Rutvij Patel, PharmD
We all know about the headaches Solvaldi’s causing, but hepatitis C isn’t the only condition for which dramatic treatments are coming to the fore. PCSK9 inhibitors for dyslipidemia are poised to enter the market in 2015, and the cholesterol lowering drugs promise to make quite an impact.
Peer-Reviewed
Albert I. Wertheimer, PhD, MBA
Frances A. Brentson, MS
Complementary and alternative medicine (CAM) seems pretty entrenched, although health plan formularies don’t usually include CAM therapies. Perhaps it is time for P&T committees to monitor outcomes from homeopathic drug studies and at least report their experience in the literature.
Contributing Voices
Peter Wehrwein

The use of new hepatitis C therapies will increase rapidly, but the effect on spending is greatest early on, according to a PricewaterhouseCoopers analysis. According to the consulting firm’s projections, the expensive medications will eventually lower health care spending because they will improve the health of people with hepatitis C patients, so liver transplants and other high-cost medical interventions will be avoided.

Source: “Medical Cost Trend: Behind the Numbers 2015,” PricewaterhouseCoopers Health Research Institute, June 2014. PwC analysis based on National Health and Nutrition Examination Survey and 2012 Truven claims data from employers.

News & Commentary
Race trumps region when it comes to which people with diabetes might be more at risk of having a leg amputated, according to the Dartmouth Atlas of Health Care Series. The Atlas says that “the lowest-risk black patients have a higher risk of amputation then nearly all nonblack patients.”
Medical Device Monitor
Katherine T. Adams
A number of products will make their debut on an ever-growing market. By the end of August, the FDA had issued 20 premarket approvals, a 43% increase over last year’s pace. This attests to the agency’s concerted effort to speed devices to the market.
Medication Management
Thomas Reinke

Domenica Rubino, MD

Liraglutide, used to lower HbA1c levels, can also help patients lose weight. It would certainly provide an opportunity for endocrinologists and primary care physicians to help obese patients, but employers have been reluctant to cover such pharmaceuticals. Health plans approach the issue with wariness.
Q&A
John Marcille

David A. Fleming, MD

The president of the American College of Physicians notes that physicians are feeling the strain these days, what with new regulations, EMRs, maintenance of certification, and more cost being shifted toward providers. Be patient, he tells doctors. Things will get better.
Snapshot
The percentage of family physicians who care for children decreased from 78% in 2000 to 68% in 2009, according to a study in the Annals of Family Medicine. Researchers also point out that “Family physicians who provide care of children are more likely to provide maternity care.”

Meetings

HealthIMPACT Southeast Tampa, FL January 23, 2015