David Hanekom, MD, and Steven Udvarhelyi, MD, are two former medical directors who became CEOs. Their new job means really understanding the business side of health care, the need for healthy members, and a healthy bottom line. But it also means watching costs and keeping stakeholders —which can include stock holders—happy.
PBM consultant Linda Cahn says that if Amazon gets into the PBM business it could insist that drugmakers simultaneously submit the net discount price for each of their drugs for the subsequent six months. Amazon could then publicize every drug’s actual price, by drug and by therapeutic category.
Some say gene editing platforms like CRISPR are a truer version of gene therapy because they are designed to home in on a particular genomic location.
That’s thanks to about 57 million unplanned sick days for workers. The prevalence of diabetes in the adult population grew from 10.6% in 2008 to 11.6% in 2016. It was at 11.5% for the first nine months of 2017.
High Caesarean section rates. Too many babies in the NICU. There are indications that maternity and newborn care in this country is far from ideal. Some payers are betting that bundled payments for obstetricians will create incentives to make changes and reduce low-value care.
The disease is endemic in Latin America, where an estimated 8 million people are affected. It is a lifelong illness and, if untreated, it can result in life-threatening health conditions. Enter benznidazole, which shows we can respond to these new threats in both a medically and an economically responsible manner.
For all the sturm und drang, experts foresee neither a hurry-up nor a halt for 2018, just a fairly steady continued rise at roughly last year’s higher-than-inflation pace. The Drug Price Forecast, for example (based on hospital and nonacute settings, but not retail pharmacy), reports that that means a tidy year-over-year increase of 7.61%.
Training primary care physicians to identify and treat oral health problems will go a long way toward integrating care for those problems with general medical care, according to a study in the Journal of the American Board of Family Medicine.
Morality rates for inpatient hospitalizations for opioid abuse quadrupled between 2000 and 2014, according to a study in Health Affairs. The mortality rates increased from 0.43% before 2000 to 2.02% in 2014. In 2016, 15,000 Americans died from heroin overdoses and 20,000 others died from overdoses from synthetic opioids.
Some experts say that investors funding innovative startup companies can disrupt American health care, making it smarter and more efficient. Others warn that incentives must change if VC money is to make a real difference. It’s a trend no one in health care can ignore.
The document “Feature and Function Recommendations To Optimize Clinician Usability of Direct Interoperability To Enhance Patient Care” offers recommendations from the clinician point of view. Widespread adoption of even a few of these recommendations by designers and vendors would greatly enhance care.
How the world looks depends on your point of view. Medical directors, some with experience as payers and providers, share their thoughts on prior authorization, value-based care, and quality measurement. One opportunity: Payers should work with specialty organizations and physician advocates to develop metrics and processes that make sense from the physician perspective.
This old standby’s ultimate demise will likely take place when cervical cancer incidence declines as the HPV vaccine starts to take effect at a population level. New guidelines are being written, but insurers could have a major influence on how closely those guidelines are followed. So far, though, they haven’t waded very far into the Pap-HPV debate.
Study results showed a modest (12%) advantage for the care management group in control of blood sugar levels, as measured by the proportion of patients whose HbA1c was under 7%. Among the obese patients, the care management group had a 16 percentage point edge (26% vs. 10%) over the usual care group in the proportion of those who lost 5% of their body weight.