Sometimes even wonderful news comes with caveats. Deaths from cancer fell for the second straight year, the American Cancer Society reports. There was a drop of 3,014 cancer deaths from 2003 to 2004, the most recent year for which information is available. This was "no fluke," says John R. Seffrin, the society's chief executive officer. He mentions tobacco control policies and breathtaking clinical advances. Managed Care's cover story next month will focus on the effectiveness of these therapies and how health plans should handle them. "Health plans face a significant challenge in determining how much cancer treatment, especially experimental treatment, they will cover," says William A. Peck, director of the Center for Health Policy at the Washington University School of Medicine in St. Louis.... A simple patient education intervention encouraged patients undergoing treatment for depression to use antidepressant medications more consistently and continuously (i.e., with fewer gaps and shorter gaps), according to research by Francisca Azocar, PhD, that was published in the Journal of Behavioral Health Services and Research. The collaboration between a managed behavioral health organization, an HMO, and a state employer, had a moderate impact on consistency of antidepressant medication use and on use of psychotherapy in combination with antidepressant medications. However, the intervention did not have an effect on the length of time patients stayed on antidepressant medications.... Giving physicians free electronic prescribing software is the solution that the National ePrescribing Patient Safety Initiative (NEPSI) has identified to address preventable medication errors, which injure at least 1.5 million Americans and claim more than 7,000 lives each year, according to the Institute of Medicine. NEPSI, a coalition led by Allscripts, a clinical software manufacturer, will provide Web-based software to physicians in solo practice or in small groups. Other members of the coalition include the technology companies Dell Computers, Cisco Systems, Microsoft, and Sprint Nextel, and the health benefits companies Aetna and WellPoint. The software can generate secure electronic prescriptions that can be sent from computer to computer or via fax to 55,000 retail pharmacies. More information is at «www.», the NEPSI Web site. Physicians may also sign up at that Web site.

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.