Another day, another projection about the coming primary care shortage. This time, it’s projected that the United States will need 52,000 more PCPs by 2025 because of population growth, aging, and expansion of the number of people with insurance coverage under the Affordable Care Act, according to a study in the November/December issue of the Annals of Family Medicine.

“The total number of office visits to primary care physicians is projected to increase from 462 million in 2008 to 565 million in 2025,” says “Projecting U.S. Primary Care Physician Workforce Needs: 2010–2025.”

The study uses the Medical Expenditure Panel Survey, administered by the Agency for Healthcare Research and Quality, to calculate PCP office visits per person. PCPs, for this study, are general practitioners, family physicians, pediatricians, geriatricians, and general internists.

“Population growth will be the largest driver, accounting for 33,000 additional physicians, while 10,000 additional physicians will be needed to accommodate population aging. Insurance expansion will require more than 8,000 additional physicians, a 3 percent increase in the current workforce,” the study says.

By 2025, the nation will need about 270,000 primary care physicians, say the authors, but they hint that the demand might be even more.

“We did not project pent-up demand and commensurate higher utilization that may occur as formerly uninsured individuals become insured.”

This known unknowable is alluded to in a recount of what took place in Massachusetts under Romneycare.

“After Massachusetts mandated health insurance in 2006, primary care wait times increased, even though the state has the second highest ratio of primary care physicians to population of any state and a robust network of community health centers,” the study states. The situation prompted Mario Motta, MD, the president of the Massachusetts Medical Society, “to declare that universal coverage does not equal universal access.”

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.