More than two thirds of primary care physicians in the United States use electronic medical records, a substantial increase from 2009, says a survey in the December Health Affairs. “Although the United States and Canada still lag behind countries with near-universal adoption, the spread has been rapid in both countries, with a 50 percent increase in the rates of use of electronic medical records since 2009.”

“A Survey of Primary Care Doctors in Ten Countries Shows Progress in Use of Health Information Technology, Less in Other Areas” looks at PCPs in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, the United Kingdom, and the United States.

Harris Interactive, using contractors in the individual countries, conducted mail and telephone surveys from March to July.

Despite the increased use of EHRs by PCPs in the United States, the researchers found a lot of doctor dissatisfaction. PCPs in the United States feel more burdened than PCPs in other countries.

“The United States spends far more than the other study countries on health care services,” says the report. “Yet U.S. primary care physicians were the least likely to be satisfied with the practice of medicine or the health system overall. U.S. studies indicate that primary care physicians’ satisfaction increases and stress decreases when care is redesigned to improve access and support the use of teams, giving physicians time to focus on sicker patients.”

Help may be on the way. “An array of policies in the Affordable Care Act envision primary care as central to efforts to achieve the Triple Aim of better health, better care, and lower costs. With major insurance expansion scheduled for 2014, there is the potential to lower access barriers for primary care and streamline insurance practices to free up physician and practice staff time to provide care.”

Responders say that they put a lot of emphasis on teamwork, and wish they’d get more feedback from specialists.

“When asked if they were always advised of changes that specialists made to their patients’ medications or care plans, fewer than half of the doctors in any country said yes. Germany, the Netherlands, and the United States were at the low end of the country range of results. It is striking that at most, about 1 in 4 doctors in any country said that information from specialists was always timely and available when needed.”

PCPs in the United States and Germany are the most negative about their health care systems, only 15 and 22 percent saying the system needs minimal, not fundamental, change.

“Insurance design also matters,” the study says. “U.S. physicians stand out, as they have in past surveys, for saying that their patients often have difficulty paying for care and that insurance restrictions on care decisions consume substantial doctor and staff time.

“The other countries in the study all provide universal coverage and, with the exception of Switzerland, have little or no cost sharing for primary care and essential medications. All of the other countries limit out-of-pocket expenses to levels well below those typical in U.S. insurance.”

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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.