A Cigna program that seeks to predict — and intercept with guidance and treatment — employees likely to miss work because of conditions that are chronic, that are likely to recur, incompletely resolved, or that are developing showed a 15 percent reduction in short-term disability claims for those employees. The study of 118,000 workers appears in the Journal of Occupational and Environmental Medicine.

The company used what it calls the Absence Prediction and Prevention program — which relies on predictive modeling to identify employees likely to go on disability in the next 12 months — and employs nurses to work with these people. “Short-term disabilities impact productivity in the workplace, but often don’t register with other predictive or risk assessment strategies that focus on future medical events,” says Robert Anfield, MD, Cigna’s CMO for disability plans.

For example, earlier Cigna research showed that people who have been out of work on family medical leave for a family reason were 50 percent more likely to have a subsequent short-term disability claim for behavioral illness than those on family medical leave for other reasons, but this risk may not be identified through the person’s medical claim history.

The employees were in Cigna’s disability and medical plans from Oct. 1, 2009 through May 31, 2010. Employee groups ranged from 2 to 21,431.

Two incentives were offered: an $80 gift card for completion of the initial health assessment by the nurse and a $120 gift card for participating in the program itself. The employees were divided into control and intervention groups.

At the 12-month follow-up, according to analysis of claims, there was a lower incidence of short-term disability in the intervention group than in the control group.

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.