Men carry a higher average account balance ($1,525) in their health savings accounts and health reimbursement accounts compared to women ($1,321), says the Employee Benefit Research Institute’s “Health Savings Accounts and Health Reimbursement Arrangements: Assets, Account Balances, and Rollovers, 2006–2010.” EBRI attributes this to the fact that men use less health care than women, allowing them to maintain higher account balances.… More than 25 percent of women diagnosed with early ovarian cancer do not receive lymph node biopsies — disheartening because lymph node biopsies can lead to improved survival, say researchers at the University of California–Davis Cancer Center and the California Cancer Registry. They found that 72 percent of patients with early-stage disease had diseased lymph nodes in the pelvis and abdomen. Five-year survival for women who had a node biopsy was 84 percent, compared with only 69 percent of those who did not have the tests. Findings were published in the journal Gynecology Oncology.… The percentage of adults 45 years and older who use a statin to control their cholesterol increased from 2 percent in 1988–1994 to 25 percent in 2005–2008 according to “Health, United States, 2010,” a report prepared by the Centers for Disease Control and Prevention’s National Center for Health Statistics. Half of men ages 65–74 had taken a statin drug in 2005–2008, compared with over one third of women in the same age group.

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.