Rates of chicken pox drop dramatically when patients receive two doses of the varicella vaccine, according to a study in the journal JAMA Pediatrics. Researchers looked at two locations: Antelope Valley, Calif., and West Philadelphia to see what happened when the two-dose regimen was introduced in 2006. Antelope Valley saw a 76% decline in varicella between 2006 and 2010; West Philadelphia saw a 67% drop.

“Declines in varicella incidence were seen across all age groups…. Varicella-related hospitalizations in the active surveillance areas declined nearly 50% during the first five years of the two-dose varicella vaccination program. With full implementation of the two-dose varicella vaccination program, it may be possible to eliminate the most severe outcomes of varicella.”

West Philadelphia, a Philadelphia neighborhood, had about 272,000 residents as of 2010; Antelope Valley had about 373,000. The data for West Philadelphia were gathered by the Philadelphia Department of Public Health’s Kids Immunization Database. In Antelope Valley, Kaiser Permanente Southern California gathered the data through its Kaiser Immunization Tracking System.

Varicella incidence after 2-dose vaccine

The solid line represents Antelope Valley, Calif. The dotted line is for a neighborhood in Philadelphia.

Varicella incidence after 2-dose vaccine

Source: “Impact of a Routine Two-Dose Varicella Vaccination Program on Varicella Epidemiology,” JAMA Pediatrics, Oct. 7, 2013

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.