View a photo of a typical city street in the 1950s and notice that most men wear hats. Times change and now, according to a study by the Altimeter Group and Definitive Insights that was done for Aetna, a typical street scene these days will show many pedestrians talking into, or fiddling with, a mobile device. According to a recent study by the fiber optics company Comcore, about 234 million people have such a device. They use them to manage their lives and, more and more, want to use them to manage their health care.

“In the past it made sense when we only had one or even a few doctors, when we didn’t move around much, and when there wasn’t really that much information to keep track of, to let the system of doctors, hospitals, and insurance companies manage our health care information,” says the study “The Coming Digital Revolution in Healthcare.” By large majorities, respondents say that having access to their health care is important. They want that access to be convenient and not, for instance, have to wait weeks for a copy of their records. They also want it organized so that it’s easy to use if they want information from multiple providers.

That’s only half the challenge. They also want to be able to share the information with all their providers, if they so choose. Respondents say that would enhance provider ability to deliver care and patient ability to make decisions about care.

Aetna recently launched CarePass to help consumers use applications, called apps when they are on a smartphone, that allow them to do things necessary to better manage their health. The first app available through CarePass, iTriage, allows users to research symptoms, find the provider that best suits their needs, and book an appointment — all from a smartphone.

“I go to the doctor once a year,” says Martha Wofford, Aetna’s vice president for “consumer platform.” “There are maybe 20 minutes where I engage with a provider all year. For me, the activities I do everyday — exercise, diet, and other preventive things — are much more relevant to my health.”

More info leads to better care and care decisions

Consumers want to manage their care through the Web, and want access to that information through their mobile devices. As the study states, “We already check our bank accounts, transfer files, and upload pictures from our smartphone and other mobile devices. Why not be able to access and manage personal health care information from a mobile device?”

Wofford notes the rise of accountable care organizations, which will share some of the insurance risk. “They’ll become increasingly interested in you as a patient,” she says. “Not just whether you are taking your meds, but if you’re a diabetic, or obese, or have other chronic conditions, are you actually following a care plan and working out and eating the right food?”

Who wants to use digital tools for better care?

Note: Data collected via an online survey of 2,000 people taken in February that was representative of the general population of the United States.

Source: “The Coming Digital Revolution in Healthcare,” Altimeter Group and Definitive Insights, March 5, 2012

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.