HMO officials may control the purse strings, but they should never forget the Beatles' advice: Money can't buy you love. Only car salesmen are considered less ethical and honest than HMO managers in a CNN/USA Today/Gallup poll that asks the public to rate 23 different professions.

Lawyers, stockbrokers, House members, senators, advertisers, and — yes — even journalists rank higher in the poll, which was conducted Nov. 14–16.

Gallup tests the same core professions each year. The poll's focus changes depending on what added professions are studied. This year, for instance, medical professions are included. Last year's focus was on business; next year's will be on government.

Other members of the health care system do much better. In fact, nurses rank higher than any other profession, with 83 percent of respondents saying the honesty and ethical standards of nurses are "very high" or "high." That has been the case in 4 out of the 5 times that nurses have been in the poll, the sole exception occurring in 2001 when firefighters, in their lone appearance after the 9/11 terrorist attacks, scored higher.

Physicians are tied for second place with veterinarians, both at 68 percent. A strong majority of Americans also has positive opinions of dentists, college teachers, the police, engineers, and the clergy.

The CNN/USA Today/Gallup findings perhaps shed some light on the results of another survey that says that employees do not trust information that they get from online sites sponsored by health plans.

Mercer Human Resource Consulting surveyed about 14,000 employees to find out just how ready workers are to become more actively involved in the selection and management of their health care benefits.

"A big opportunity seems to lie in helping employees sort through the best health care Web resources," says Mike McAllister, one of the survey's authors. Unfortunately, he adds, "We now know that health plans and employers are not viewed as credible sources for health care information."

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.