The recent 40th anniversary of the surgeon general's report on smoking brought some staggering statistics to the public's attention. The New England Journal of Medicine reports that "In 2001, the prevalence of smoking in the United States stood at 25.5 percent among men and 21.5 percent among women, down from the peaks of 57 percent among men in 1955 and 34 percent among women in 1965. Rates of smoking have plateaued, however, since 1990.... Smoking rates are declining among all age groups, except among persons 18 to 24 years of age, among whom the prevalence rose from 23 percent in 1991 to 27 percent in 2000."

Figuring out how much money the health system may have saved as a result of the campaign against smoking is a "very complicated story," says Ken Warner, PhD, the director of the tobacco research network at the University of Michigan.

"You may have heard the argument made by the tobacco industry's experts in the trials, which is true, that if people don't smoke, they live longer. If they live longer, they're prone to get old age diseases," says Warner. "While that is true, it is also true that at a given age, survivors of smoking will tend to cost more than people who never smoked. So even if you're 80 years old, when you're a smoker, you're going to cost more."

After years of being in the thick of this debate, Warner, an economist, cautiously opines that smoking does indeed save the health care system money. However, he challenges the question. "Nobody ever asks how much money do we save by treating breast cancer," says Warner. "In fact, if we went on the basis of asking how much money do we save by doing x, y, z — this may sound facetious, but it's true — far and away the least expensive health care system would be to outlaw health care." Warner insists that the relevant question is: "What is cost-effective?" Smoking cessation is the gold standard in cost-effectiveness. "There's very little that the health care system can do to improve the health of their patients at a reasonable cost that compares with smoking cessation."

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.