Almost 90 percent of Americans know that antibiotics can treat bacterial infections, but a third also believe that they can fight viral infections as well, according to a poll done by the Pew Charitable Trusts for the Centers for Disease Control and Prevention. This type of information is followed closely by public health policy experts in light of the soaring growth of antibiotic superbugs. . . . The number of accountable care organizations (ACOs) will nearly double next year, the Centers for Medicare & Medicaid Services predicts. There are currently 153 ACOs that contract with Medicare. That could grow to 300 next month as new contracts are approved. . . . The preterm birth rate continues to drop, with the 2011 rate the lowest in 10 years, according to the March of Dimes in its 2012 Preterm Birth Report Card. The 2011 rate of 11.7 percent marks the fifth year in a row the preterm birth rate has dropped. About 64,000 fewer babies were born prematurely in 2011 than were born in 2006. Still, there’s a long way to go: More than 500,000 are born too soon. . . . A link between statins and surviving cancer is being explored. Patients taking these anticholesterol drugs were 15 percent less likely to die of cancer than were people not taking statins, according to a Danish study published in the New England Journal of Medicine. The study didn’t look at whether the statins prevent cancer, only at what happens after diagnosis. . . . One of the things health insurance experts will be watching as the Affordable Care Act goes into effect is the number of self-insured employers. Now there’s a benchmark, thanks to a study by the Employee Benefit Research Institute, which examines the growth of self-insurance. In 1998, 41 percent of employees belonged to such plans. In 2011, the study finds, that number jumps to 59 percent. Companies that self-insure can offer uniform benefits across state lines, which can ease the administrative burden and lower expenses. They can also avoid state-mandated benefits. Many large employers jumped at these perks, and increased enrollment in such plans was fueled almost exclusively by companies with 1,000 or more workers. In the meantime “The percentage of workers in self-insured plans in firms with fewer than 50 employees has been close to 12 percent in most recent years examined in this analysis,” says the study.

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.