Other countries have demonstrated the benefits of a national tracking and monitoring registry for surgical implants, but the United States has been lagging.

Now a medical device registry set up by Kaiser Permanente that tracked 85,000 joint surgeries is helping clinicians provide better care and lower costs, as the incidence of replacing the devices can be lowered.

Robert S. Namba, MD, an attending physician and coauthor of the study, says, “We wanted to see what factors were associated with early failures or re-operations on total hips or total knee replacements.”

The researchers categorized the factors affecting re-operation into patient and surgical factors. For total knee replacement, a patient was more likely to have a second operation on the surgically repaired knee if he was younger than 55.

“Knee replacement was designed for patients 65 and older, but the procedure became more common and successful so patients had the surgery at younger and younger ages. Many patients who are younger and more active tend to have arthritic knees. But these patients are at high risk for failures, or re-operations,” says Namba.

Creating registries can be a major benefit to managed care, says Namba. “Being able to follow patients who are being treated within your organization is very valuable. With the proliferation of electronic medical records, it facilitates the access to integrated databases so that we can know what other medical conditions our patients might have, or how our patients are doing compared to others.”

Registries don’t have to be set up for unique or difficult-to-treat conditions, he says.

“The ability to track any common procedures or medical conditions will pay dividends to those who develop them.”

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.