Twenty percent fewer physician assistants chose to go into primary care in 2010 than in 1996, according to a recent study in Annals of Family Medicine. “Although the absolute number of PAs working in primary care has increased overall, the percentage of PAs in primary care has declined from 50.8 percent in 1996 to 31 percent in 2010,” the study states.

The study (http://www.annfammed.org/content/11/1/75.full.pdf+html) notes that health care has a problem with primary care. Fewer physicians are taking that career path at a time when — thanks to the Affordable Care Act — the system will begin relying more heavily on PCPs. However, the study adds that “Demographics associated with an increase likelihood of primary care practice among PAs appear to be similar to those of medical students who choose primary care. Knowledge of these characteristics may help efforts to increase the number of primary care PAs.”

The study, in the January/February issue, defines primary care as family medicine, general pediatrics, and general internal medicine. Women, Hispanic and PAs over age 40 are more likely than their colleagues to go into primary care. “Overall, we found that PAs working in primary care have demographic characteristics similar to those of medical students who choose general primary care specialties,” the study states. “A 2010 systematic review determined that six factors are associated with a medical student’s commitment to primary care practice: female sex, older age, Latino ethnicity, lower socioeconomic status, receipt of a National Health Service Corps scholarship, and intention to practice in primary care at the time of medical school matriculation.” The study says that the PA profession might want to consider pushing “policy measures that successfully increase the number of primary care clinicians, including loan repayment, improved levels of reimbursement for primary care physicians, and expansion of Title VII, Section 747 of the Public Health Service Act, which aims to increase the quality, size, and diversity of the primary care workforce.”

Percentage of physician assistants practicing in primary care by demographic characteristics: point estimates and 95% confidence intervals

Trend in the percentage of primary care PAs by year of graduation from 1975 to 2008

% of PAs in primary care practice

Source: “Physician Assistants in Primary Care: Trends and Characteristics,” Annals of Family Medicine, January/February 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.