More public universities are requiring students to have health coverage, according to the Associated Press. This may not have too much of an effect on insurers. "In most cases students are covered to age 25 under their parents’ insurance," says Arthur N. Leibowitz, MD, a former chief medical director at Aetna who now runs a company, Health Advocate, that helps consumers get a handle on managed care. Many of the hundreds of thousands of students covered by health insurers are graduate and foreign students, he adds.... The price tag for the Medicare prescription drug benefit keeps growing. Figures released by the Congressional Budget Office on March 4 say that the benefit will cost 849 billion over a 10-year period ending in 2015, up from the $720 billion figure released in February which, in turn, was up from the $534 billion projection of December 2003 which, in turn, was up from the approximately $400 billion projection bandied about before the legislation was passed. Phew! Looking for a silver lining? Well, the CBO’s recent projection does not include expected savings that could actually make the cost lower than the Bush administration’s current estimate of $724 billion over those 10 years. We’ll see.... We’re living longer, according to an examination of more than 2.4 million death certificates from 2003. The certificates, about 93 percent of those issued that year, were examined in a report by the CDC’s National Center for Health Statistics. Mortality rates declined in categories such as heart disease, cancer, stroke, HIV, and chronic respiratory disease. The average age for U.S. residents increased to 77.6 years.... Diabetes-related hospitalizations are a huge drain on health care finances, according to a study by the Agency for Healthcare Research and Quality. Preventing such events could save the United States about $2.5 billion. In 2001, 30 percent of people who were hospitalized for diabetes, wound up having two or more hospital stays. Costs for those patients averaged $23,100, compared to $8,500 for patients who were admitted once.

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.