The journal Neurology’s release last month of a study on Alzheimer’s generated headlines across the United States because of the daunting conclusion: The number of patients with the disease will nearly triple by 2050. What didn’t attract as much attention, but will concern physicians and health insurers, is the researchers’ contention that there may not be a way to stem this trend.

“It has been suggested that these numbers would decrease substantially if an intervention was identified that merely delayed the onset of AD dementia,” says the study “Alzheimer Disease in the United States (2010–2050) Estimated Using the 2010 Census.”

Yet, it would take time for the intervention to decrease the prevalence of the disease, the authors argue.

“An intervention whose effects were most pronounced in the earliest stage of disease would also have delayed impact on future prevalence. For instance, if the measure was effective only if implemented by age 50, there would be no change in the projected bulge from the baby boomers because all baby boomers are at least 50 now.”

As Thomas Morrow, MD, who writes Managed Care’s Tomorrow’s Medicine department, pointed out in May 2011(, “The course of AD is highly variable and can be present in mild forms for long periods of time. In fact, detailed neuropsychological testing can detect mild cognitive impairment” years before a diagnosis is confirmed.

About 5 million people suffer from Alzheimer’s currently. That’s expected to rise to about 14 million by 2050, the study says. To project incidence and mortality, the study’s authors relied on statistics from the Chicago Health and Aging Project, along with 2010 U.S. Census estimates of population growth.

The changed projections “were not attributable to a single factor, but rather to small variations in multiple components…. The update to the projected population numbers for 2050 contributed the largest change to the projected [Alzheimer’s] prevalence for that year. The population aged 65 years or older projected for 2050 increased to 88.5 million from 81.7 million in the previous projections. However, this is also the time most distant from the present and therefore the most difficult number to estimate.”

Estimated number of people with Alzheimer’s disease (AD) in the United States in 2010 and projections through 2050, in millions

Predicted number of people in the United States with Alzheimer’s disease in percent of the group affected, by age group and year

Source: “Alzheimer Disease in the United States (2010–2050) Estimated Using the 2010 Census,” Neurology

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.