Patients undergoing chemotherapy have not lost access to care, despite federal legislation that reduced payments to oncologists, according to a study issued by the Duke University Clinical Research Institute (DCRI).

Critics of Medicare Part D feared that if the payment schedule for oncologists were reduced and they weren’t being paid as much for the chemotherapy drugs they were giving their patients, “patient care might suffer if doctors had to close their practices or scale back, making it necessary for patients to travel farther or go to inpatient facilities for treatment,” says Kevin Schulman, director of DCRI’s Center for Clinical and Genetic Economics. “Our study showed that this, in fact, has not yet occurred.”

Researchers at DCRI studied the treatment of patients with leukemia, lymphoma, breast, lung or colorectal cancer from 2003, before the act was passed, through 2006.

“The distance patients traveled for chemotherapy treatments did not considerably increase after passage of the act,” says lead investigator, Lesley Curtis, a health services researcher at DCRI. “And despite concerns that patients would have to go to inpatient settings with longer wait times, we observed a small shift in the provision of initial chemotherapy from inpatient to outpatient settings,” says Curtis.

The median amount of time between diagnosis and treatment was 28 days. This did not change significantly, regardless of treatment setting, says Curtis.

The findings were published in the Journal of the American Medical Association.

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.