Inexpensive wound dressings used to promote healing of venous leg ulcers have been shown to be just as effective as the more expensive antimicrobial silver dressings, according to a study published in the British Journal of Surgery. The study demonstrated that routinely using the inexpensive dressings could save the National Health Service of the United Kingdom millions of pounds a year. Could the same be said across the Atlantic?

“There’s very little data to show that silver dressings are better than the inexpensive variety,” says Anil Hingorani, MD, an associate professor of surgery at the State University of New York (SUNY) Downstate Medical Center. “The simple compression dressing is the gold standard.”

In the British study, researchers followed 213 leg ulcer patients who received either standard low-adhesive dressings or antimicrobial silver dressings. The group that received the silver dressings had a median healing time of 67 days, while the control group had a median healing time of 58 days. The patients were followed for one year, with 96 percent of patients from both groups showing ulcer healing. But the average cost of treating a patient with silver dressings was £417.97 (about U.S. $682), including staff time and materials — about 30 percent higher than the £320.12 (about U.S. $522) it cost for the group that received the standard compression dressings.

“First-line therapy for these wounds is to use compression dressings, but I can understand the appeal of the antimicrobial silver dressings because they are newer,” says Hingorani. Although it is the surgeon’s decision as to which type of dressing to use, “health plans are hesitant to pay for the silver dressings because data demonstrating their cost-effectiveness have been scarce,” he says.

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.