John Marcille

John Marcille

Timothy J. Stezzi — Tim to those who know him — created this publication 21 years ago and now goes into well-deserved retirement. I think. Tim is the sort of guy who is likely to start another enterprise from scratch, or run for office, or decide that his considerable skills might be worth passing on and find himself back in the classroom teaching.

He’s leaving us, that much we know. He will be much missed. His steady hand and business acumen helped calm the waters of the creative chaos needed to put out a magazine each month. Tim kept true to the vision that compelled him to jump into the “entrepreneurial sea” in 1991. “The quality of the publication — of the editorial content — is what matters,” Tim says.

As it happens, I have been with the magazine almost as long. Anyone with knowledge of the publishing world understands how rare that is. Editors often clash with publishers, and some publishers replace editors almost at whim. It can be a brutal business.

Tim and I have had our differences over the years, but Tim follows a code in his dealings with others. “The publisher/editor relationship can be antagonistic, but only if the publisher or the editor wants to dictate the direction. If they’re on the same path with the same goal, then there should be less friction.” And there has been precious little friction.

Tim’s legacy will be carried on by his business partner, with whom he launched MANAGED CARE, Timothy P. Search, who is president and group publisher at MediMedia Managed Markets. Tim and Tim sold MANAGED CARE to MediMedia some years ago and continued to oversee the publication, all the while pursuing other projects for the company. Tim Search will be working with our new publisher, Maureen Dwyer Liberti, to keep MANAGED CARE the pre-eminent magazine in the managed care industry. Wish them luck. And Tim Stezzi? By all means, wish him luck too, but he has always been able to make his own luck. Best wishes, Tim Stezzi!

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.