The push to bring physician offices into the 20th century, let alone the 21st century, continues. Only about 15 percent of physician practices have electronic information systems, according to the National Committee for Quality Assurance. The organization aims to change that, in part by offering financial rewards to tech-savvy doctors through its Physician Practice Connections, part of the NCQA's Bridges to Excellence pay-for-performance program.

"There's probably no single more important step a doctor or medical group can take than to incorporate information technology into their practice," says NCQA President Margaret E. O'Kane. "It makes the difference between having all the information you need to provide exactly the right care, and relying on memory and educated guesses. The latter just isn't good enough anymore. Health information is crucial — that's what the PPC program promotes."

The NCQA has unveiled the new standards for public comment at «http://www.ncqa.org». Public comments were to be accepted through Oct. 11, with the final standards to be published in early 2006.

Another pay-for-performance program in upstate New York hopes to tap into bonuses offered by Bridges to Excellence as well. That, however, would be icing on the cake for participating doctors who came together to get a health information technology network up and running in order, in part, to garner P4P bonuses from individual health plans.

"Many health plans are prepared to pay for performance," John Blair, CEO of Taconic Health Information Network and Community, tells the New York Times. "The rub is that you have to have the technology in place to garner those incentives. You need to automate the reporting capability."

Taconic is a collaboration of 500 physicians who don't want the technological revolution to pass them by. The program, launched with $100,000 in seed money from the not-for-profit eHealth Initiative, is being watched by federal officials with an eye for making President Bush's goal of having all Americans' medical histories put on electronic medical records.

Taconic physicians pay a monthly subscription fee of $500 to $600. It's well worth it, says Eugene P. Heslin, MD. "The large groups can afford the software," Heslin tells the Times. "For the onesies and twosies, small groups like ours...." the cost is prohibitive.

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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.