Last year, for the first time in over 50 years, America spent less on health care than it had in the previous year, according to a study by the IMS Institute of Healthcare Informatics. The price tag was still hefty — $325.8 billion —but it was 1 percent below 2011. Per capita, we spent $898, down $33 from 2011. Experts cite the expirations of patents for such blockbuster drugs as Lipitor and Zyprexa.... Wellness programs take a hit in a new Rand report, Reuters is reporting. Such programs have only modest success, according to the report, which collected data from about 600 employers with at least 50 workers. Al Lewis, founder of the Disease Management Purchasing Consortium, tells Reuters that the most motivated employees tend to sign up, making it impossible to gauge success. Lewis was more blunt when he talked to Managed Care in March, describing the wellness industry as made up..... Testicular cancer rates are on the rise, with the increase seen mostly among Hispanic men, according to new research. The information comes from a national epidemiology database. Researchers tracked testicular cancer rates from 1992 through 2009. The incidence of testicular cancer appears to be increasing very slowly but steadily among virtually all groups that were studied, Scott Eggener, MD, an associate professor of surgery at the University of Chicago tells HealthDay News. “The novel finding is that the most dramatic increase is in Hispanic men.” He does not know why that is.... Black and Hispanic women diagnosed with breast cancer are likely to wait longer to get treatment than white women, according to researchers at the University of California–Irvine. They can’t really say why it happens, as is also true for numerous other studies pointing to disparities in treatment along racial and/or ethnic lines. Researchers analyzed the records of 8,860 women age 15 to 39 who were diagnosed with breast cancer between 1997 and 2006. Eight percent of white women waited six weeks before getting treatment; 15 percent of black and Hispanic women waited the same amount of time.

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.