The demand for primary care physicians (PCPs) started to increase long before the Affordable Care Act became law and promised to flood PCP offices with millions of people who had been uninsured. First, there was the little matter of medical school students following the money and realizing that they could make a lot more as specialists (/archives/2007/6/what-primary-care-physician-shortage-means-health-plans).

It comes as no surprise, then, that for the seventh straight year primary care practitioners (family medicine and internal medicine) are the most highly sought physicians, according to a survey by the search company Merritt Hawkins. The survey tracks 3,097 recruiting assignments the company conducted from April 1, 2012, to March 31, 2013.

There are other causes for demand as well. For instance, we’ve watched the rise of retail clinics for some time (/archives/2006/6/retail-medical-clinics-draw-patients-payers). Apparently, so have consumers.

Merritt Hawkins cites “a proliferating number of health care service sites, including multihospital systems, large medical groups, urgent care centers, retail clinics, free-standing emergency departments, academic centers, community health centers, government facilities and traditional community hospitals” as driving PCP demand.

“The new mantra in health care is to be ‘everywhere, all the time,’” says Mark Smith, Merritt Hawkins president. “This means reaching into communities with a growing number of free-standing facilities or other sites that are convenient and accessible. These facilities have one thing in common — they all need primary care physicians.”

Note also that nurse practitioners and physician assistants weren’t even part of the survey until a few years ago.

Primary care physicians are most often the subject of recruitment requests

Note: The numbers represent requests for recruitment

Source: Merritt Hawkins’ 2013 Review of Physician and Advanced Practitioner Recruiting Incentives

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.