Timothy Kelley

Sometimes you can learn as much from the wastebaskets in a magazine's office as you can from the gleaming new issues in the lobby. Notes from a meeting on this month's cover are all that's left of one editor's proposal to symbolize the leisure time physicians gain when they accept a salaried position. That editor (okay, it was I) was rightly outvoted for suggesting a picture of a golf bag. The image represents leisure, but also evokes an old cliché about physicians and the fairways that might offend some doctor readers.

A colleague didn't fare much better with the idea of a time clock as an emblem of salaried employment. This time it was HMOs and other employers of physicians who could, we feared, be put off. The idea of employees punching in and out smacks of factories and assembly lines — the very last notion of themselves that managed care organizations wish to encourage.

Instead, as you've seen, we chose an image of the shingle some physicians have relegated to the attic as they've accepted salaried positions — the shingle most of their colleagues now emerging from residency won't hang up to begin with. But I wonder if there isn't something to be learned from the pictures we discarded and our reasons for discarding them.

The physician's role in society has long been special. Poll findings suggest that the public still views doctors with a tinge of envy — witness the golf cliché and the popular notion that physicians are overpaid. But that envy is combined with a level of esteem that others — Congress, for example — can only dream of. One challenge for salaried physicians is to avoid being misperceived either as country clubbers or as clock-punchers, and in so doing to build on the respect they already enjoy to help patients develop a new accountability for and participation in the maintenance of their own health. Such patient accountability, happily, is one idea we didn't throw out; you'll find it discussed in John La Puma, M.D.'s Ethics column.

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.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

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.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

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.