This probably does not come as a surprise to clinician executives, but there seems to be a link between level of education and overall health. The University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation ranked the relative health of people in more than 3,000 counties in the United States. The counties with more college-educated residents tended to do better, with fewer premature deaths. People smoked less, exercised more, and had fewer preventable hospital stays.... Gastroenteritis continues to be a growing problem, and not just in the developing world. The Centers for Disease Control and Prevention says that deaths in the United States caused by gastroenteritis rose from 7,000 to 17,000 between 1999 and 2007. Researchers say that most of the deaths are attributable to two types of bacteria: Clostridium difficile and norovirus.... Melanoma’s on the rise as well, according to the Mayo Clinic. Looking at decades of diagnoses in Olmsted County, Minn. (part of the Rochester Epidemiology Project), Mayo researchers found an 800 percent increase in incidences of melanoma in young women and 400 percent in young men. Researchers looked at first-time diagnoses in people 18–39 from 1970 to 2009.... Eat less if you want to lose weight. That’s timeless and good advice, but patients years ago did not have the distractions of fad diets, pre-made meals, and pills. Researchers at the Beth Deaconess Medical Center in Boston found that the obvious approach worked best and that fad diets showed “no association with successful weight loss.” This was reported in the American Journal of Preventive Medicine.... Doctors are breathing a sigh of relief with last month’s announcement of the new deadline for converting to the ICD-10 code system. The old deadline had been Oct. 1, 2013. The new one is exactly one year later. Vitera, a practice management software vendor, recently surveyed 394 physicians and medical office staff members and found that 85 percent of respondents ranked the transition to ICD-10 one of the top concerns facing their practices.

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.