Hospitals lose

Opportunities Abound in Reform’s Wake” in the May 2010 edition fails to address that the reform is going to help insurance companies who never help hospitals. Hospitals will be closing.

David McCarthy, RPh
Director of Pharmacy Services
New England Sinai Hospital
Stoughton, Mass.

In patients’ hands

Thank you! “Put DM in Doctors’ Hands,” in the March 2010 issue, is what we family docs have been saying all along (reference my Viewpoint in the April edition).

Granted, some of us are better than others at working toward helping our patients, and we do know our patients better than a nurse at the end of the phone line.

We know when our patients are, shall I say, stretching the truth, and we know how we can best get them to change. The end result, however, is that the patients have to want to change. Nothing happens if they don’t want to change.

Gail Dudley, DO, MHA
Lake Primary Care Associates
Tavares, Fla.

Worthy program?

It will be interesting to see where the suggestions made in the January 2010 article “States Collect Valuable Data on Hospital Prices and Performance” will lead us.

With the economy the way it is and with health care reform on the horizon, programs like this might provide the way to real reductions in cost.

Evelyn Elliott, RPh, MHA
Director of Pharmacy Services
Kern Medical Center
Bakersfield, Calif.

Unconstitutional

I believe the mandates discussed in the March 2010 article “Many States Preparing Laws Rejecting Individual Mandate” to be unconstitutional at the federal level. States should reserve the right to regulate health care within their state.

It is noble of state governments to at least attempt to block federal mandates. Someone needs to stop the out-of-control federal government.

Todd White, PharmD
Director of Pharmacy Services
Clark Regional Medical Center
Winchester, Ky.

Clinical processes

We have to start learning to adapt to the many changing circumstances in health care as suggested in “DM Grows, Though Under Fire” in the March 2010 edition.

An important breakthrough with this would be to provide consistent clinical processes for patients across the board.

Carmichael Moultrie, RPh, MS
Manager of Pharmacy Services
Dekalb Medical Center Downtown
Decatur, Ga.

Nice job!

I found “Medicare Gets Serious About Payment Cuts” in the April 2010 issue to be very informative. The article brought to light many issues.

Joe Wohlwend
Clinical Pharmacist
Choate Mental Health Center Pharmacy
Anna, Ill.

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.