An aging population that includes too many people who are obese or overweight will drive up the costs associated with heart disease substantially by 2030, says a study in Health Affairs. One of the problems is that the health care system will be victim to the success of treatments that will keep heart disease patients alive longer. Society should focus more on prevention, the researchers argue.

“The question of whether to make treatment or prevention of cardiovascular disease a higher priority had often been debated, and most researchers have suggested balanced approaches,” they write in “More Americans Living Longer With Cardiovascular Disease Will Increase Costs While Lowering Quality of Life,” in the October issue of Health Affairs. “However, our findings suggest that substantial reductions in incidence are crucial: Otherwise, improvements in mortality from cardiovascular disease (along with aging and obesity trends) will lead to a troubling increase in prevalence.”

The average 10-year risk of heart disease will rise to about 15% for men and 9% for women by 2030, from a baseline of 12.7% and 6.8% in 1991, the study states. Researchers used data from the National Health and Nutrition Examination Surveys to make their forecast.

In addition, they relied on meta-analyses of cholesterol and blood pressure treatment. “Physical activity was not included as a risk factor because a high proportion of relevant data was missing and definitions of physical activity changed....”

The authors add that “improvements in treatment of cardiovascular disease and smoking rates have not outweighed (and will not outweigh) the influence that rising age and obesity have had on increasing total risk of cardiovascular disease.”

Disturbing forecast

Prevalence of cardiovascular disease in the United States for men and women ages 25–85, selected years 2000–10 and 2015–30

Linear trend lines added for trend analysis (solid lines) and projections (dotted lines). Lighter shaded points for years 2015–30 are projections.

SOURCE: “More Americans Living Longer With Cardiovascular Disease Will Increase Costs While Lowering Quality of Life,” Health Affairs, October 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.