Fifty-nine percent of prescriptions for mental health medications are written by family physicians, not mental health specialists, which raises concern about the quality of some treat ments, a new study indicates. The research, conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) and Thomson Reuters, examined 472 million prescriptions written for psychotropic drugs from August 2006 to July 2007. The study found that primary care physicians wrote the bulk of prescriptions in two main categories — antidepressants and stimulants.

The researchers said the findings are important because published independent research suggests that most people treated for depression are more likely to get adequate care in specialist psychiatric settings than from a family physician.

Jeffrey Buck, PhD, a researcher for the survey and chief of the survey, analysis, and finance branch in the Center for Mental Health Services at SAMHSA, says that these findings “underscore the need to recognize that nonspecialty providers play a significant role in the treatment of mental disorders.

“It may not be too surprising to see that nonpsychiatrists are accounting for the majority of stimulant prescriptions, especially for children,” says Buck, “because only about half of antipsychotics are being prescribed by psychiatrists. The rest are being prescribed by other types of physicians and other types of health care providers, such as nurse practitioners or physician assistants.”

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.