Big Data and artificial intelligence are likely to have the greatest impacts on how health care is delivered next year, according to a Silicon Valley Bank survey of 122 founders, executives and investors in health-tech companies. Forty-six percent of respondents went with Big Data; 35% said artificial intelligence.

The good news is that the maternal mortality rates around the world fell by more than a third from 2000 to 2005. The New York Times, citing data from the Institute of Health Metrics and Evaluation, reports that the maternal mortality rate in the United States rose from 23 per 100,000 births in 2005 to 28 per 100,000 in 2013. “The findings are part of a gathering body of evidence on the dismal numbers for maternal mortality among American women and how they keep getting worse.”

Pennsylvania has been one of the states hardest hit by the opioid epidemic, with more than 3,500 people dying from the drugs last year. Michael Ashburn, MD, MPH, guest blogs today on the Philadelphia Inquirer’s health section and points out that the epidemic started with the best of intentions: relieve pain. 

Susan Ladika

Katherine Hempstead

Individual insurance policies purchased outside of state health insurance exchanges are not going to vanish any time soon. The 9 million Americans who buy such policies usually make too much money to be eligible for subsidies and can often get coverage with a broader network of providers.

Anthem and Cigna accused each other of violating the terms of their proposed merger in letters last month, and that’s one of the issues the government brought up in filing an antitrust lawsuit over the deal, Bloomberg reports. Big bucks are involved. There’s the $48 billion deal itself. And then there’s the$1.85 billion Anthem would owe Cigna if the government blocks the merger. Sometimes, it comes down to personalities.

Insurers picked up 30% of the $78.5 tab for battling opioid abuse in 2013, the CDC reports. Included in the calculation: direct health care costs, lost productivity and costs to the criminal justice system, HealthDay reports, citing a study published in Medical Care. Nearly 2 million Americans abused opioids that year, and about 16,000 people died from drug overdoses, a dramatic rise over 2007, the most recent year data were measured.

Heather Bresch had a rough day yesterday. The CEO of Mylan NV, the maker of the much-in-the-news EpiPen allergy shot, was grilled by the House Oversight and Government Reform Committee, Bloomberg reports. Committee members played hardball, questioning Bresch’s ethics and wondering just why she’s worth $19 million a year. At the center of it all: the $600 price for a two-pack of EpiPen, yet one more example of the public’s growing dismay over the cost of new therapies.

Election 2016: Seniors
Robert Calandra
Clinton wants to expand the program, while the Republican platform calls for replacing entitlements with premium support to buy insurance. Meanwhile, seniors have few complaints because the ACA actually sweetened the deal for Medicare beneficiaries in some respects. Most notably, it gradually eliminates the “donut hole.”

Anyone who’s had to care for an older person in the twilight years knows that the rough ride often starts with the falls. This hasn’t escaped the notice of experts, either, who are starting to refer to an epidemic of falling, the Milwaukee Journal Sentinel reports.

Obamacare could use a little good news right now. Everybody’s heard about the high-profile departures of some of the biggest health insurance companies from the ACA exchanges. But Molina Healthcare, a company that made its name as a Medicaid managed care plan, is cleaning up, the Hill reports. Molina always had to rein in costs and get the best quality bang for its buck, the plan’s CEO Mario Marino, MD, explains.

Thankfully, very few children aged 5 to 11 take their own lives, but attention deficit disorder (ADD) is the reason they do, according to a study in Pediatrics. Eight-seven children in that age bracket took their own lives between 2003 and 2012. Meanwhile, during the same period, depression was the leading cause for the 606 adolescents aged 12 to 14 who did.

The CDC wants Americans to become more aware of the dangers of sepsis to the point where it’s one of the things they’ll ask doctors about when symptoms appear, the New York Times reports. Sepsis usually affects people over 65, but all ages are susceptible, even children. Between 1 million and 3 million people get it each year, and 15% to 30% of them will die.

Even though the ACA helped provide coverage for ex-prison inmates, gaps still remain, according to a study in the Journal of Internal General Medicine. “Given the high prevalence of mental illness and substance use disorders among justice-involved populations, persistently elevated rates of uninsurance and other barriers to care remain a significant public health concern,” the study states.

Election 2016: Employers
Charlotte Huff
The Cadillac tax, which has drawn fire from both Democrats and Republicans, was initially slated to go into effect in 2018 but last year Congress delayed it until 2020. But it remains an election-year point of friction, with proposals ranging from repeal to modifications.

Nothing conclusive can be drawn from data about the first year of CMS’ voluntary Bundled Payments for Care Improvement initiative, according to a report the agency issued Monday. “There have been modest reductions in Medicare episode payments for select clinical episode groups with isolated instances of quality declines and fewer instances of increased quality,” the report states.

Concerns about the over-prescribing of antibiotics have long been voiced, but the problem still persists, according to a CDC study in JAMA Internal Medicine. Bacteria grow increasingly immune to treatment. Too many hospitals, according to the study, respond by prescribing even more powerful antibiotics, drugs once considered a treatment of last resort. In what appears to be the first national, multiyear estimate of U.S.

The FDA overruled the recommendations of its own advisory committee to approve Exondys 51 (eteplirsen) to treat Duchenne muscular dystrophy, a rare and lethal form of the disease that affects about 15,000 Americans, reports Kaiser Health News (KHN). The rocky road to approval is something Managed Care has been following for awhile.

Election 2016: Hospitals
Robert Calandra
Passage of the ACA in 2010 led to some merger mania. Proponents of mergers and acquisitions say they can lower costs by creating economies of scale and smoothing the way for all kinds of clinical integration. But others say the fact that they can doesn’t mean they do.

Results for many clinical trials that would now never see the light of day will be made public, thanks to new federal guidelines. The rules, announced Friday, will strengthen rules in place since 2007 that mandate the reporting of clinical trials involving humans that investigate new therapies for cancer, diabetes and heart disease.

After all the talk about insurers focusing more on patients, all the discussion about consumer satisfaction, the health care industry still has a way go, reports Modern Healthcare. The article begins by documenting one woman’s frustration with dealing with health care cooperatives, which were supposed to be a low-income alternative under the ACA but have been dying on the vine, as has noted.

One epidemic begot another. A lobbying group called the Pain Care Forum had been telling Congress for years about a crisis in pain, in which patients are not getting enough pain medication that they need, the Philadelphia Inquirer reports. In 2012, drugmakers and their allies in the forum sent a letter to legislators saying that more than 100 million adults suffer from chronic pain.

Insurers and employers hoping to encourage healthier lifestyles among their health coverage beneficiaries know that they have their work cut out for them. Take diet. Public policies that attempt to change dietary habits face challenges that public policies against smoking can sidestep. Tell someone to stop smoking, but that he or she can smoke one or three times a day, and pretty soon that person is back to their old habits. No one can go cold turkey off of eating.

Two recent studies on cancer say that people with private insurance are diagnosed earlier and live longer than those on Medicaid or the uninsured. Both studies were published in Cancer.

One looks at the survival rate for over 13,000 patients with one kind of malignant brain tumor (glioblastoma multiforme or GBM) between 2007 and 2012. The other looked at over 10,000 patients diagnosed with testicular cancer between 2007 and 2011.

Some good news in the war against cancer. The death rates for children and teens has declined. The cancer death rate for children aged 1 through 19 dropped 20% from 2.85 to 2.28 per 100,000 children between 1999 and 2014. Treatment of pediatric cancer is a relatively niche discipline: 1,785 children and teens died of cancer in the U.S. in 2014.

Value-Based Care
Michael D. Dalzell
The FDA never issued regulations to clarify the boundaries of promotion of pharmacoeconomic data, something it’s been dragging its feet on for nearly 20 years. In turn, pharma companies, fearful of being penalized for off-label promotion, have erred on the side of caution, hesitating to take advantage of Section 114.
Election 2016: Physicians
Richard Mark Kirkner
Physicians are a disparate lot. At last count, there were more than 300 member organizations of the American Association of Medical Societies. These organizations tread common ground on a host of issues in play in this upcoming election cycle. They also part ways on some important issues, including their stance on the Affordable Care Act.
Election 2016: Pharma
Jan Greene
When the election ends, the time for rhetoric will be over and the new president and lawmakers will face the task of actually managing a giant, unwieldy, and complex health care system, trying to wrestle drug costs into submission before they wreck more havoc on the budgets of Medicare, Medicaid, and the American consumer.
Election 2016: Insurers
Joseph Burns
Whether insurers are rejoicing at the prospect of a Trump presidency and the end of the Affordable Care Act or a Clinton presidency and modifications to the law is hard to say because of the industry’s complicated relationship with the law. AHIP, for instance, has been conflicted about the ACA from the beginning.
Editor’s Desk

Things aren’t looking too hot for the ACA exchanges right now.

UnitedHealthcare, Aetna, and Humana are abandoning the exchanges in many markets. Upstart Oscar is jumping ship in New Jersey and Dallas. Sixteen of the nonprofit co-ops that were supposed to be the lite version of the public option have folded.

All of this bad news about the exchanges has fired up the health care commentariat and wonkery.

Here are nine opinions, analyses, and takeaways about the ACA exchanges, what the bad news means, and what might be done about it.