Using “joy” and “primary care physician” in the same sentence can be downright provocative these days, as the authors of a study that does just that point out. “We set out in search of joy. What we found were pockets of professional satisfaction.”

Specifically, the authors — who include Thomas Bodenheimer, MD, a member of Managed Care’s Editorial Advisory Board — focus on 23 high-performing primary care practices to find out “how these practices distribute functions among the team, use technology to their advantage, improve outcomes with data, and make the job of primary care feasible and enjoyable as a life’s vocation.”

Their study, “In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices,” is in the May/June issue of the Annals of Family Medicine (

“We question why young people would devote 11 years preparing for a career during which they will spend a substantial portion of their workdays, as well as much of their personal time at nights, on form-filling, box-ticking, and other clerical tasks that do not utilize their training,” the study states.

They also question whether patients are being optimally served by this situation.

The study’s authors shadowed physicians for a day and also met with administrators and clinical leaders.

The study looks at seven methods that make practices more efficient. They are:

  • Reducing work through pre-visit planning and pre-appointment laboratory tests
  • Adding capacity by sharing the care among members of a team
  • Eliminating time-consuming documentation through collaborative documentation and nonphysician order entry
  • Saving time by ordering medications for an entire year in some cases
  • Reducing unnecessary physician work by having a nurse or physician assistant passing on to the physician only information that specifically requires a doctor’s expertise
  • Improving team communication through huddles and more formal meetings
  • Improving team functioning by, for instance, having a medical assistant and physician sit side by side

The study notes, “No single practice has solved every issue; each practice still struggles to overcome its own set of constraints.”

Case studies illustrate the effectiveness of different approaches. For instance, six of the practices have nurses or medical assistants enter the orders and follow up with the patient.

“At the Cleveland Clinic Strongsville, primary care physicians work with two medical assistants or one medical assistant and one registered nurse.”

They take notes while the physician talks to and examines the patient.

“After one year of the new model, average daily visits increased from 21 to 28, thereby improving access and continuity.

“Revenue was up 20% to 30%, which has exceeded the cost of the additional medical assistant or nurse.”

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.