A U.S. General Accounting Office report says 11 percent of state licensure actions against physicians that were reported to the National Practitioner Data Bank had inaccurate or misleading information.... Payments made to physicians jumped 5.2 percent in 1999, while accounting for 32 percent of health care cost increases that year. A study by the Center for Studying Health System Change also notes that prescription drug spending was associated with 44 percent of the 1999 increase.... More than 90 percent of physicians consider a drug's cost before prescribing it for patients who pay for it out of pocket, but only 30 percent do the same when patients have a drug benefit, according to findings published in the Annals of Internal Medicine.... Retail prescription sales through mail order grew 27 percent from mid-1999 to the middle of last year, according IMS Health. More than 7 of every 10 prescriptions distributed through the mail were branded products, compared with 59 percent at traditional retail pharmacies.... Seventy percent of benefits administrators named rising health care costs as their top priority in a Deloitte & Touche survey.... The National Committee for Quality Assurance now offers purchasers customized health plan report cards. Seven private employers and the U.S. Office of Personnel Management are the first to try the online program, which gives employees detailed accreditation and HEDIS data about the plans that are available to them.... Three insurers — Group Health Cooperative, Premera Blue Cross, and Regence Blue Shield — have re-entered Washington State's individual market, which had been without private insurers for more than a year.... Name change department: Empire BlueCross and BlueShield is now Empire HealthChoice, Alabama's Health Partners HMO becomes the Oath, Advance Paradigm is now AdvancePCS, and the National Wholesale Druggists' Association has taken the curious moniker of Healthcare Distribution Management Association.

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.