In a recent survey, primary care physicians (family practitioners, internists, and pediatricians) were asked about their attitude toward pay for performance (P4P), in which physicians are financially rewarded for achieving positive outcomes and high patient satisfaction scores.

Only 7.3 percent endorsed the concept fully, while 40.6 percent indicated it is “a good idea but data are lacking” to implement it. Nearly 40 percent indicated that P4P is a bad idea because “it is difficult to quantify the performance of primary care physicians.” And a little more than 14 percent said they are not familiar with P4P.

The 2008 Survey of Primary Care Physicians, conducted by the recruitment and staffing company Merritt Hawkins & Associates, was mailed to 10,000 primary care physicians selected at random from a national physician database.

In comparison with past surveys, fewer physicians in 2008 were disappointed with their incomes than were disappointed in 2007 and 2006, which may indicate that high demand for primary care services has had at least some positive effects on physician income.

Also, about 75 percent indicated that they plan to continue practicing over the next five years, suggesting that their practices are at least sustainable over that period.

Despite this, however, the survey indicates that incomes for primary care physicians were flat over the last year while overhead costs were up. Only 27 percent said that their practices were financially robust.

Source: Merritt Hawkins & Associates. 2008 Survey of Primary Care Physicians

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.