Let’s start with the familiar caveat: More research is needed. Nonetheless, three studies that conclude in that way offer interesting insights into what three conditions may contribute to heart problems.

The studies look at links to psoriasis, arthritis, and depression.

A preliminary study presented last month at the annual meeting of the American Academy of Dermatology (AAD) says that “the more body surface area that is affected by psoriasis, the higher the likelihood that the patient will have metabolic syndrome — a group of cardiovascular risk factors of obesity, hypertension, insulin resistance and increased triglycerides,” according to a statement by the AAD (http://bit.ly/yhMdOO).

About 7 million Americans suffer from psoriasis, but 3 million of them may not be aware of it. Psoriasis patients have a specific kind of LDL cholesterol that is “more likely to promote hardening of the arteries and promote heart attacks,” the ADA says.

The AAD cites one study that says that patients with severe psoriasis die about five years earlier than those without, and 50 percent of those deaths are because of cardiovascular disease.

Meanwhile, a study in the Annals of Rheumatic Disease (http://bit.ly/GDAXff) finds that women with hypothyroidism and inflammatory arthritis have nearly four times the chance of developing heart disease as do women without those conditions.

Hennie G. Raterman and colleagues, of the VU University Medical Center in Amsterdam, looked at 175,000 patients and found that “after adjustment for age, hypertension, diabetes, and hypercholesterolemia, women with hypothyroidism plus inflammatory arthritis had an odds ratio of 3.72 for heart disease, compared with controls. . . .”

Then, there’s the study in Copenhagen that says that the risk of mortality increases in patients who are depressed and who have gotten stent implants (http://bit.ly/GBXoMF).

“The main finding is that patients who are depressed after coronary artery stenting have a worse prognosis,” says Nikki Damen, lead researcher. “They die earlier than nondepressed patients.”

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.