The AMA capped a less-than-harmonious convention by selecting its board chairman, Thomas R. Reardon, M.D., as its 1999 president. Reardon turned away a challenge from former Chairman Raymond Scalettar, M.D., in the AMA's first contested presidential election in five years.

Reardon and other AMA leaders were pounded at last month's meeting in Chicago, where member after member used floor time to criticize the association's handling of the Sunbeam endorsement debacle. To put a twist on the old Watergate-era refrain, some wanted to know what Reardon knew and when he knew it. Others demanded an accounting of expenses in settling a $20 million breach-of-contract suit that Sunbeam filed after the AMA jettisoned the deal.

Meanwhile, the AMA's 1998 president, Nancy Dickey, M.D., accepted her coronation with health care financing in her crosshairs. Dickey, whose cause célèbre for her year in office is insurance issues, said she would like to see people given the option to shop for health benefits that suit their own needs, rather than be limited by the choices their employers offer.

Dickey proposed that employers designate an amount of money for workers to spend on health care, mixing and matching benefits any way they want. If an employee wants a richer benefit mix than what an employer is willing to fund, it would be up to the worker to pay extra. Employers would no longer contract with individual plans, but would allow employees to sign with any plan in the market. (A similar idea, though, is treading water in Washington.)

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.