Far from final words on obesity were splashed across headlines last month when the Centers for Disease Control and Prevention announced that the condition is responsible for 112,000 deaths annually in the United States. That's considerably fewer than contained in a March 2004 CDC report, now discredited, that put the number of yearly deaths from obesity at about 400,000. The newer report even suggests that overweight people (BMI of 25–29.9) might live longer than those classified as having normal weight.... Most uninsured people do not pay taxes, because they have low incomes, and would therefore not be likely to enroll in tax-free health savings accounts, according to a study by the Commonwealth Fund. However, Larry Akey, a spokesman for America's Health Insurance Plans, tells the Boston Globe that, "Our preliminary [survey] shows that roughly a third of the individuals who are buying this product were previously uninsured." This will continue to be watched closely.... To no one's surprise, General Motors blamed its largest quarterly loss in more than a decade on the increased costs of providing health care coverage for 1.1 million workers, retirees, and dependents. The company lost some $1.1 billion in the first quarter. GM officials have been complaining about health care costs for quite a while.... Every silver lining has its cloud, UnitedHealth Group learned last month. First-quarter earnings were up 41 percent but lower-than-expected growth in health plan enrollment has investors worried that we may be in for a new round of price competition.

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.