Frank Diamond
Managing Editor's Memo

Back before our first distant amphibious ancestors emerged from the primeval ooze onto a landscape that looked more like the surface of the moon than Mother Earth, say the 1970s, the great spin on public perception seemed to be that diabetes is not so bad as you might think. I say "seemed" and I mean "seemed." I have no proof, no hard research — only anecdote based on an increasingly faulty memory.

Here's what I recall. In the 1970s, the message was that diabetes is not a death sentence. (Not so different from what's being said about cancer these days.) I remember hearing that Mary Tyler Moore, for instance, has diabetes and look what she's accomplishing. There were other famous sufferers, as well.

The message (at least as received by this non-expert): We can live with diabetes. It now appears that we're living a little bit too much with it as our cover story lays out in some detail.

Contributing Editor Martin Sipkoff shows how the costs are ballooning and incidence is up and going to go higher. Much higher.

For health plans, it is an issue of financial survival. Isn't everything? Numbers help order priorities, however, and should push diabetes management toward the top of the list. Luckily, again as our cover story makes clear, many management approaches are being tried, with some success and more promise.

What I missed back in the 1970s, either because I wasn't paying attention or the message wasn't broadcast, was just how terrible diabetes can be. I've since learned, after watching loved ones die of the disease, and finding out that it runs in my family. Diabetes is chronic, debilitating, and often deadly, and no amount of cheeriness on the part of "Mary Richards" can sugarcoat that.

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.