Physicians in Michigan are angry and vow that they're not going to take it any more. The Michigan State Medical Society and the Michigan Osteopathic Association are suing Blue Cross Blue Shield of Michigan after the health insurer cut

500 doctors from its provider network. That is about 5 percent of the physicians in the plan networks that serve the Big Three automakers, whose concern about the rising cost of health care prompted the insurer to make the move.

In the meantime, an additional 1,900 doctors quit voluntarily after the plan announced that it would reduce payments for a range of medical services, the Wall Street Journal reports. "They are trying to whittle away at the amount we can charge by forcing us to charge what they want us to," Betty Chu, MD, a gynecologist in Clarkston, Mich., tells the newspaper.

Robert J. Stomel, DO, the MOA's president-elect, says that the health insurer and the Big Three "believe they can force physicians to discount their fees without input as to how these arbitrary conditions may affect access of UAW members and their families to physicians of their choice."

But Lisa DeMoss, the senior vice president and general counsel for the insurer, indicates that physician performance is being used to decrease the ranks of the provider networks, saying that the plan "included some practitioners with less cost-effective patterns of care." She tells the Wall Street Journal: "Cost is an issue for all purchasers of health care products today. To the extent that you have a product that is not performing up to expectations, nobody is going to buy it."

This is the latest salvo in the Big Three's battle to cut the costs of health care. "We're pretty tough on how we purchase health care and despite that, our costs are going up a lot," John Devine, GM vice chairman and CEO, tells the WSJ.

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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.