UnitedHealthcare seems to be jumping onto the accountable care bandwagon in a big way. The insurer says it plans to increase payment to providers through contracts linked to quality and cost-efficiency to $50 billion by 2017. “Our unparalleled experience with accountable care models — and there are many — demonstrates that they can work better for everyone in health care, from patients to payers to care providers,” says Austin Pittman, the president of UnitedHealthcare Networks.... Meanwhile, WellPoint must pay a fine of $1.7 million for exposing the personal information of over 600,000 beneficiaries because an online application database could be hacked. WellPoint informed those who may have been affected and beefed up online security. The hacked data includes names, birthdates, addresses, and Social Security numbers.... You can knock yourself silly exercising but that doesn’t necessarily mean you’ll lose weight, according to researchers at the University of Washington. Even though Americans are exercising more, the obesity epidemic continues to grow. We still consume more calories than we burn off, says the study’s senior author Ali Mokdad, PhD, at the university’s Institute for Health Metrics and Evaluation.... Americans are living longer but not necessarily more happy lives compared to other countries. A study of health statistics in 34 countries published recently in the Journal of the American Medical Association shows that rates of substance abuse, psychiatric disorders, and muscle and joint pain all increased in the United States in the last 20 years. Life expectancy in the U.S. increased from 75.2 in 1990 to 78.2 in 2010.

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.