In one of the most dramatic comebacks in health care, 80% of hospitals and over 50% of doctors’ offices will receive incentive payments this year for installing electronic health record systems that meet government meaningful use standards, according to the Department of Health and Human Services.

It was only a few months ago that the New England Journal of Medicine warned that doctors and hospitals were very behind in their EHR upgrades (http://tinyurl.com/standards-blog-item).

This is something HHS also notes. In 2008, only 17% of physicians and 9% of hospitals were eligible for incentive payments.

“We have reached a tipping point in adoption of electronic health records,” says HHS Secretary Kathleen Sebelius.

There are 15 core objectives that must be met in order for the government to underwrite up to $44,000 in new technology spending per physician.

As of May 1, more than 291,000 health care professionals, mostly physicians, and over 3,800 hospitals have received incentive payments.

“In four years, they’ve made more progress then in the previous 20 years,” Farzad Mostashari, the national coordinator for health information technology at HHS, tells USA Today.

The incentive payments are part of the American Recovery and Reinvestment Act of 2009 (“the stimulus”).

HHS in its announcement notes that “Health IT systems give doctors, hospitals, and other providers the ability to better coordinate care and reduce errors and readmissions that can cost more money and leave patients less healthy.”

All well and good, but some experts wonder how much the Affordable Care Act, which fosters EHR use, might bump into other laws.

They worry that HIPAA and state confidentiality laws are getting in the way of efforts to coordinate care across sites of service.

“I respect patients’ need for privacy, but do you really care if someone knows that you broke your arm and went to the hospital?” Craig Garner, a lawyer and health care consultant, told us last month in our cover story on problems with ACA implementation. “Historically our country has cut back rights in times of war. If we really are in a war on health care, let’s get rid of HIPAA and HITECH. They’re obstacles to health care reform.”

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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.