State budgets got an unexpected gift last year. Medicaid spending declined in 2006, the first time that has ever happened. Medicaid spending fell 1.4 percent in the first nine months of 2006, USA Today reports. After adjusting for the rate of health care inflation, the decline was 5.4 percent.... Regence BlueShield has decided not to launch its Select Network plan for 45,000 Boeing workers in Washington state. The health plan pulled back as a result of a lawsuit filed by a physician and some patients that claims that the tiered network rates physicians with unproven measures of efficiency. The lawsuit is the first inspired by an effort by the American Medical Association to challenge insurers that the AMA says use unproven measures of efficiency to profile docs. The AMA says that Aetna's Aexcel, Cigna's Care Network, and UnitedHealthcare's Premium Physicians may also be challenged.... Mortality rates for hospitals ranked high on a government Web site were not that much better than those for hospitals ranked low. Researchers at the University of Pennsylvania reviewed 2004 data on the Hospital Compare Web site, which is run by the Centers for Medicare & Medicaid Services. The study was published in the Journal of the American Medical Association and a JAMA editorial says that the results "raise questions about the appropriateness of using Hospital Compare performance measures as the basis either for pay-for-performance systems or for consumers to identify better-quality hospitals." More discussion about this issue is sure to come.... It looks likely that Massachusetts Gov. Mitt Romney will run for president. That means that the state's universal health care plan might become the focus of debate, and even perhaps the model for a federal overhaul of the health care system. Massachusetts officials say that they've been overwhelmed by requests from officials from other states to discuss the plan. Stay tuned.... Probably nobody ever moved to California because the HMOs there offered the lowest premium rates in the country. Good thing, because that is not the case anymore, according to a survey by the California HealthCare Foundation, a charity organization funded by money the state garnered when Blue Cross of California converted from a not-for-profit to a for-profit organization. HMO enrollees there paid premiums that were in line with what enrollees everywhere paid last year.

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.