Current practice guidelines suggest that certain low-risk patients with pulmonary embolism (PE) can be treated in the outpatient setting, but physicians rarely follow them. A new randomized, multicenter study shows that outpatient care can sometimes be used in place of inpatient care — reducing hospitalizations and costs.

“The findings support a shift in clinical management of PE for a substantial portion of low-risk patients, which may reduce hospitalizations and costs,” says Donald M. Yealy, MD, senior author of the study and chairman of the department of emergency medicine at the University of Pittsburgh School of Medicine.

Yealy and colleagues looked at more than 300 patients in 19 emergency departments in Switzerland, Belgium, France, and the United States who had been randomly assigned to inpatient or outpatient care between February 2007 and June 2010. These patients were stable and judged to have a low risk of death.

Outpatient care was as safe and as effective as inpatient care. One outpatient developed recurrent venous thromboembolism within 90 days. Of the patients who received inpatient care, none developed that condition.

Patient satisfaction rates regarding care were comparable, exceeding 90 percent for both groups, and both groups had essentially the same numbers of hospital readmissions, emergency department visits, and outpatient visits to a physician’s office within 90 days. However, the savings from reductions in hospital stays might be partially offset by increased frequency of home-nursing visits.

“Findings were consistent with previous research that show that outpatient care of PE is associated with low rates of recurrent venous thromboembolism, major bleeding, and death,” says Yealy. “Patients with PE prefer outpatient treatment, and these reassuring trial results should prompt physicians to consider such care more often for low-risk patients.”

Thomas Morrow, MD, a former medical director at Matria Health and a current member of the MANAGED CARE Editorial Board, says that while the study is optimistic, “There are issues like ensuring patient access to a pharmacy that stocks the medication, and patient compliance” that need to be addressed before a patient is considered a candidate.

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.