John A. Marcille
MANAGED CARE February 1997. ©1997 Stezzi Communications

John A. Marcille

Time. For most of us, it's among the most precious commodities. Anything that gives more time than it takes, and doesn't cost too much in other commodities (money, prestige, honor...) deserves our attention.

Will the automated medical record give more than it takes?

In this month's cover story, starting on page 10, writer Jean Lawrence addresses many of the issues raised by this concept and gives us a snapshot of how several institutions are trying to reach the goal of a comprehensive, automated patient record.

But is it a worthy goal? Assuming, perhaps rashly, that issues of confidentiality can be satisfactorily resolved — and I mean in a way satisfactory not just to the health care community but to patients and others who could suffer from inappropriate dissemination of medical records — having a patient's complete medical record available to a physician at any time, at the hospital or in the office, with minimum fuss, will contribute greatly to improved care for individuals and populations, reduced errors and ultimately (not immediately) reduced costs.

To make the AMR a reality, everyone must benefit. Programmers need to look beyond the obvious. It's a fine thing to promise "decision support," but if it works as well as the spelling checker in our "state-of-the-art" word processing program, which usually questions perfectly sound usage and misses actual errors, physicians will be rightly irritated.

Under pressure to increase productivity, they must not be saddled with systems that slow them down, except for a minimal — really minimal — period to learn the system.

Don't look for the fully automated medical record any time soon. You'll find comprehensive records available on-line in a hospital or physician's office or, of course, a group- or staff-model HMO, but when care is rendered in many locations, especially ones contractually unrelated to the patient's health plan, the automated medical record is still a dream.

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.