Only half to three-fourths of stroke survivors who had been discharged from the hospital were still using preventive medication two years later, according to a large Swedish study published in Stroke: Journal of the American Heart Association. This disconcerting finding can be seen as an opportunity that health plans can take advantage of by providing clinical support and patient education to providers and members. Preventing a second stroke by improving adherence to a medication regimen becomes all the more important.

“To prevent new cardiovascular events after stroke, preventive drugs should be used continuously,” says Eva-Lotta Glader, MD, PhD, lead investigator. “Yet the proportion of patients who were persistent users of drugs prescribed at discharge from hospital declined steadily over the first two years.”

After two years, only 74.2 percent of patients were still taking antihypertensive drugs, 56.1 percent were still taking statins, 63.7 percent were still taking antiplatelet drugs, and 45 percent were still taking warfarin. Glader points out the rapid declines for statins and warfarin and says that effective interventions need to be developed to improve persistent secondary prevention after stroke.

The recommendations to take preventive medications after a stroke are very similar here in the United States, says Bruce Ovbiagele, MD, associate professor of neurology and director of the stroke prevention program at UCLA.

“These medications are recommended to be taken indefinitely” after a patient has had a stroke, says Ovbiagele.

“I suspect if you tried to conduct this type of study nationally in this country, first, you’d have a lot of difficulty, and second, you’d find the drop-off even more drastic and much earlier,” says Ovbiagele.

Ovbiagele points out that in the study, patients who were discharged from the hospital and who subsequently received institutional care were more likely to continue taking their stroke prevention medications. Managed care might benefit from the findings by “having a system in place to make sure patients remain on their medication. I think patients need some system in place to remind or prompt them to continue taking their medications.”

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.