Massachusetts is in the forefront of a growing patient drive for greater public access to background and performance information on physicians. Republican Gov. William Weld recently signed a law, said to be the first of its kind in the nation, that gives Massachusetts citizens access to detailed profiles of physicians practicing in the state. The measure could pave the way for similar efforts in other states.

"It's an experiment that's being watched across the country," says Dale L. Austin, deputy executive vice president of the Federation of State Medical Boards.

Physician data provided to consumers will include doctors' malpractice histories on paid claims for the most recent 10 years, disciplinary actions taken against a doctor, and criminal convictions for felonies or serious misdemeanors. Con-sumers also will be given information to help them review the liability records and put them in context.

Information about the revocation or involuntary restriction of hospital privileges for reasons relating to competence or character also will be provided. Consumers will receive details on a doctor's education, training, board certification and the number of years he or she has been practicing.

Even though some physicians in the state opposed the measure, the Massachusetts Medical Society worked to win its enactment. Pressure was building in the state for tough new profiling requirements after the Boston Globe printed a series of articles about the inability of the Massachusetts Board of Registration in Medicine to punish several physicians who had been sued repeatedly for malpractice.

"It would have been foolish for us to fight the drive for this [measure]," says MMS President Joseph Heyman, M.D. "It made a lot more sense to show patients that we are happy to release information on physicians as long as it isn't unfair."

The profiles will be made available by the board of registration, which will administer the program. Consumers may obtain the data by calling a state-funded 800 number and requesting up to 10 profiles at a time.

Ohio Bill Would Make Regulation More Consistent

Some managed care plans in Ohio will face new state regulations if a measure introduced by Republican State Sen. Karen L. Gillmor becomes law. Several other states, including Iowa and New Mexico, are watching the developments there carefully and may follow the Buckeye State's lead.

At present Ohio, like many other states, has a hodgepodge of health plan regulatory mechanisms that vary depending on the type of plan. With the industry in constant flux, Gillmor points out, new entities are evolving all the time and assuming risk without being properly licensed. If enacted, proponents say, the proposal will "level the playing field," making sure that the state's regulations apply to the whole industry.

The measure would rewrite Ohio's managed care laws to establish one set of insurance rules for all plans assuming risk. A major objective is to provide more protection to consumers who are at risk of losing health care services.

The Ohio Department of Insurance currently has jurisdiction over traditional health insurers and HMOs. But in response to calls about other kinds of other health care organizations, says Gillmor, "the department has to tell consumers that they are dealing with unregulated companies, which gives consumers very limited rights."

Under the proposal, all managed care organizations must meet a minimum capital requirement of $1 million to ensure that funds are available to pay consumer claims.

— Joan Szabo

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

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The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

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Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.