Radiology called "area to watch"

Aging baby boomers, fewer people choosing the medical field, and early retirements are all helping to shift hospital demand from primary care physicians to specialists. Martin/Fletcher surveyed 2,960 hospitals in 45 states and 4,265 clinics in 39 states to get a better read on what hospitals want. Primary care physicians are still in demand, but not to the degree they were in the early and mid 1990s. Instead, the survey reflects a growing need for specialists such as orthopedics, anesthesiologists, and radiologists. "Due to the aging of the baby boomer population, there is more need for hip replacements, knee scopes and elderly related surgeries," the report's authors note.

Pharmacists, nurses being lured

Retaining physicians isn't the primary concern for hospitals — other providers are in even more demand. Those most sought include pharmacists and nurses. A survey of 3,960 hospitals in 48 states shows great competition to "keep pharmacists in the hospital setting and also recruit new grads." In the meantime, nurses are retiring earlier and, according to the American Association of Colleges of Nursing, 3,000 fewer nurses have graduated from baccalaureate programs in the last five years. Salaries offered to pharmacists and nurses by cash-strapped hospitals reflect just how much in demand they are.


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.