Chest X-rays do not save lives when used to screen for lung cancer, according to a 20-year study reported in the Journal of the National Cancer Institute. Mayo Clinic/NCI researchers found that imaging led to no reduction in mortality, but revealed many "clinically insignificant" tumors, inviting potentially unnecessary treatment.... "California, open your Golden Gate?" Only so we can leave, say physicians. State and county medical societies report a physician exodus, thanks to comparatively low capitation rates and the state's high cost of living. The Census Bureau confirms California dropped from 8th to 12th in the '90s in ratio of doctors to population.... Congress will consider restoring $21 billion in Balanced Budget Act cuts to Medicare providers over five years. Enough? Hospitals seek $25 billion, nursing homes want $17 billion, and health plans say they need $15 billion.... The Health Care Financing Administration will pay Medicare physicians about five percent more in the aggregate next year, thanks to higher reliance on RBRVUs. The upshot: Higher pay for primary care, less for specialties.... Direct-to-consumer pharmaceutical advertising will top $2 billion this year, for the first time, says Scott-Levin, the consulting firm.... Try it: An analysis in the Journal of Health Promotion suggests daily practice of transcendental meditation could prevent illness to the tune of $5 billion a year.

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.