The unfortunate distinction of being the state with the highest number of obese adults goes to Mississippi. According to a study by Trust for America’s Health and the Robert Wood Johnson Foundation, 35 percent of Mississippi’s adults are obese. “Obesity has contributed to a stunning rise in chronic disease rates and health care costs,” says Jeffrey Levy, executive director of the Trust for America’s Health. Colorado, at 21 percent, has the lowest obesity rate.... Electronic health record system vendors aren’t leaving behind a healthy ratio of satisfied to dissatisfied providers, according to the research company KLAS. “The replacement rate spiked over last year from 30 percent to 50 percent, especially in larger practices,” says the report “Ambulatory EMR Perception 2012.” The study uses data from 318 physician practices. Forty-four percent of practices that are replacing EMR systems are doing so because of product problems. Another 15 percent cite service problems.... Old women who receive radiation treatment after a lumpectomy are less likely to have to undergo a mastectomy later, according to a study published in the journal Cancer. The study, which looks at women age 70+, found that 10 years after a lumpectomy those who had follow-up radiation treatment had a 3.2 percent risk of mastectomy. Those who did not had a 6.7 percent risk. That’s a 67 percent reduction in the risk for mastectomy for the radiation group, the journal reports.... Hearing loss screenings for adults 50 and older should be done judiciously, says the U.S. Preventive Services Task Force. A hearing test should be done only if the patient shows symptoms or complains to the doctor. “If you have a hearing problem, you should absolutely bring it up with your doctor,” Albert Siu, MD, the co-vice chairman of the task force, tells Reuters Health. Also, doctors should not hesitate to inquire.... Drug-releasing stents prevent more adverse cardiac events than bare metal stents do, according to a study in the August 22/29 issue of the Journal of the American Medical Association. The study looks at about 1,200 patients in Israel and Europe who had a STEMI (an ST-segment elevation myocardial infarction).At the 1-year point, researchers found that 4.3 percent of patients with the newer model stents suffered adverse events, compared to the 8.7 percent of patients who used the older style stents. The study concludes that “Compared with a bare-metal stent, the use of biolimus-eluting stents with a biodegradable polymer resulted in a lower rate of the composite of major adverse cardiac events at 1 year among patients with STEMI undergoing primary PCI.”

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.