When Kaiser Permanente Northern California rolled out a new electronic health record (EHR) system for outpatients a few years back, a team of researchers considered it a golden opportunity to evaluate how such systems affect care and outcomes.

The staggered implementation of the EHR system at 17 KP-owned medical centers from 2004 to 2009 allowed researchers to “examine the association between use of a commercially available certified EHR and clinical care processes and disease control in patients with diabetes,” says the study “Outpatient Electronic Health Records and the Clinical Care and Outcomes of Patients With Diabetes Mellitus” in the Oct. 12 issue of Annals of Internal Medicine.

Mary Reed, DrPH, the lead author, tells Managed Care that “patients’ diabetes and cholesterol control were actually significantly better when their physicians used an EHR compared to when they didn’t. We found that the patients who needed the most care, meaning their lab values were furthest out of control, were most helped by using the EHR.”

The study included nearly 170,000 patients and found that use of EHRs led to better control of diabetes and dyslipidemia.

The report says that when an EHR was used, patients with the greatest needs got increased testing, treatment, and physiologic improvement, and people already meeting glycemic and lipid targets had “decreased testing and treatment intensification.”

There’s a lot at stake, the study points out. Federal incentives for “meaningful use” of certified EHRs total about $29 billion, as much as $44,000 per doctor, and financial penalties for lack of certified EHR begin in 2015.

“The outpatient EHR completely replaced the paper-based medical record and a limited patchwork of pre-existing nonintegrated health IT tools” at the 17 medical centers,” says the study. “Use of those early health IT tools was limited because paper-based alternatives were still in use.”

It’s good to know that the investment will be worth it because “even with federal incentive payments … implementing a complete EHR system requires a large up-front investment in money and time, with careful coordination....”

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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.