Lights! Camera! Scalpel? Some employers are experimenting with steering their workers toward Web sites in which they can see videos of actual surgeries. "There is the diabetic foot-ulcer procedure, in which forceps peel away dead tissue as blood drips down the foot," the Wall Street Journal reports. "There is the skin-cancer footage, in which a scalpel cuts into the fine, wrinkled skin on the hand of an elderly woman. And there's the cataract video, which shows a needle piercing an eye, while a narrator explains that the needle is used to 'fragment the lens into thousands of little pieces and suction it' away."

Stop! Which, the article suggests, is the sort of reaction employers want workers to have. As in stop smoking, stop overeating, stop drinking too much, or face this. It's the latest development in the consumer-directed health care movement, though it remains to be seen just how widespread use of surgery videos, and less graphic video simulations, will become.

Most insurers and employers haven't signed on yet. One that did is Lumenos, a subsidiary of WellPoint. Employer clients of Lumenos offering the surgery-simulation videos to workers include the city of Las Vegas and Fujitsu America. Lumenos contracts with a company called Graphic Surgery for use of the video simulations. (Another company, WorldDoc, created the live-action surgery video, which Lumenos does not use.)

"Graphic's video service costs $8,520 a year for a company with 1,000 workers, with additional employees priced at a discount," the Journal reports.

Both Graphic and WorldDoc also provide estimates of how much companies will save as a result of employees adjusting their lifestyles because of having seen the videos.

However, Abbie Leibowitz, MD, cofounder and chief medical officer of Health Advocate, which advises patients on health insurance issues, questions whether a video is enough to encourage lifestyle adjustment. Also, he wonders if the motives of businesses that offer such screenings might be questioned.

"It seems that the idea here is possibly to show consumers how gory surgery is and scare them out of having it," says Leibowitz. "Whether looking at bypass surgery on video is going to convince someone to change his lifestyle in a long-term, meaningful way, or give up tennis to avoid a knee injury, I think is a stretch."

Still, Leibowitz adds, making more info available to workers doesn't hurt. The videos are a "nice complement" to other educational material offered by Graphic and WorldDoc.

"Access to good health information is increasingly important for consumers," says Leibowitz.

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.