Two major studies on mental health say that while strides have been made in awareness of the problem and the willingness of patients to seek help, much more needs to be done.

One study, by the National Institutes of Health and published in the New England Journal of Medicine [Vol. 352:2515-2523, No. 24, June 16, 2005], shows that health insurance coverage and the intervention of primary care physicians are two of the main reasons for a significant increase in treatment rates over the last 10 years.

The other study, the National Comorbidity Survey Replication, published in the Archives of General Psychiatry [Vol. 62, No. 6, June 2005], says that while more people are indeed seeking help, most fail to get adequate care.

The NIH study, funded in part by that agency's National Institute of Mental Health, says that those treated for an emotional disorder increased from 12 percent in the early 1990s to 20 percent between 2001 and 2003.

PCPs prescribing more medications for depression and other mental disorders account for the showing that the largest increase in treatment rates happened at those doctors' offices.

"Probably the most positive message out of the paper is the amount of true increase in treatment that is documented here," psychiatrist Darrel Regier, research director for the American Psychiatric Association, tells the Las Vegas Sun. "I think that is the result of a decrease in the stigma."

The newspaper adds that "experts also tied rising treatment to broader insurance coverage and more treatment programs, especially among corporations."

The NIH study notes that "The prevalence of mental disorders did not change during the decade (29.4 percent between 1990 and 1992 and 30.5 percent between 2001 and 2003 ....)" The data for that study were collected from 5,388 U.S. residents in the early 1990s and 4,319 people from 2001 to 2003.

Meanwhile, the Wall Street Journal reports that the National Comorbidity Survey Replication shows that "only one-third of affected people received even 'minimally adequate' care — which was defined by researchers as getting at least two months of appropriate medication and seeing a doctor at least four times, or undergoing at least eight psychotherapy sessions of 30 minutes or more."

The article notes that there is some debate about the broad criteria used to describe mental illness. For instance, some worried that including milder symptoms such as panic attacks inflates the overall numbers and alerts payers to a "bottomless pit of possible demand." Data for that study were collected through face-to-face interviews with 9,282 U.S. residents from 2001 to 2003.

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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.

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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.