A lot can change in 10 years, but not a ruling by the U.S. Preventive Services Task Force (USPSTF) about screening tests and possible treatments for early cognitive impairment. In 2003 the USPSTF said that there was insufficient evidence for or against. The task force has reaffirmed that position.

The screenings are meant to be performed by primary care physicians, and while they might detect dementia, “there is no empirical evidence that screening improves decision making” because there’s the question of whether interventions will do more harm than good.

“Expert consensus guidelines state that early detection of cognitive decline may be beneficial because clin­icians can optimize medical management, offer relief based on better understanding of symptoms, maximize decision-making autonomy and planning for the future, and offer ­appropriate access to services that will ultimately improve patient outcomes and reduce future costs,” the study states. “Although this is a logical argument, there is little or no empirical evidence to support it.”

The study “Screening for Cognitive Impairment in Older Adults: A Systematic Review for the U.S. Preventive Services Task Force” is in Annals of Internal Medicine. It includes a meta-analysis of approved anti-­dementia drugs that show only a slight benefit, say the authors.

“The average effects of changes in cognitive functioning observed in trials are small, and the clinical importance of population benefits is probably negligible when commonly accepted thresholds are used.”

Not everyone is convinced. David Knopman, MD, of the Mayo Clinic, worries that primary care physicians will totally abandon dementia screening. He tells MedPage Today that doctors should have a good reason to screen and should not do so just because a patient is old.

“On the other hand, if they detect that a person is making mistakes with medications, the person isn’t following their directions, the person is having more auto accidents than can be accounted for by chance....” — these are signs that should not be ignored.

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.