Stop the presses! The Centers for Disease Control and Prevention want you to know that being obese or overweight is definitely not good for you. Why point out the obvious? Because it turns out that a recent CDC study that indicated that overweight people might live longer than normal weight people may have been based on skewed data. Hence, the counterintuitive results. Critics pointed out that the normal-weight group contained people with heart disease and cancer who weigh less because of those diseases. CDC Director Julie Gerberding held a news conference in which she apologized for any possible confusion and added that obesity is indeed a "serious epidemic" in this country.... Who's pointing fingers? The AMA called on state attorneys general to require health insurers to provide patients with updated and accurate physician listings. Managed care companies must provide patients with a realistic choice of network physicians that offer services in a broad array of locations and specialties."Physicians are concerned that managed care companies are misleading patients with erroneous or artificially inflated lists of participating physicians," said AMA President-elect William Plested, MD, during the annual meeting.... Tough times at General Motors. The auto manufacturer lost $1.3 billion on North American operations in the first quarter of 2005. The company plans to cut 25,000 jobs by 2008, and close some factories. CEO Rick Wagoner pins much of the blame on escalating health care costs. GM wants its unionized workers to pay a bigger share of health care costs. The United Auto Workers responds by saying that any unilateral action by GM to reduce benefits would be a "huge mistake." Stay tuned.... Profits are surging at the nation's HMOs, according to Weiss Ratings. HMOs earned $8.9 billion during the first three quarters of 2004. That's an increase of $2.3 billion, or 33.6 percent, over the $6.7 billion earned in the same period in 2003.

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.