Physicians and hospitals will become more integrated in the next three years, according to a survey by the Deloitte Center for Health Solutions (http://tinyurl.com/Deloitte-doc-survey). [Harry Greenspun, MD, senior adviser for health care transformation and technology at the Deloitte Center for Health Solutions, says, “While the term “integrated” was not specifically defined for respondents, physicians commonly interpret it to encompass a broad spectrum from loose affiliation to outright employment by a hospital.”] This, of course, continues a trend whose ramifications for health insurers we’ve explored (http://tinyurl.com/provider-power). Primary care physicians (PCPs) and surgeons are most likely to think that this will happen, but there is clear agreement among all providers.

The Deloitte survey says, “Physicians consolidated in the past one to two years to gain or retain income security (29% of all physicians who had consolidated) or leverage negotiation power with payers (21% of all physicians who had consolidated).”

Most physicians are pessimistic about the future of medicine, with 57% saying that the practice of medicine is in jeopardy and 72% that the best and brightest might not consider a career in medicine. Physicians believe that they face a trade-off between clinical autonomy and bargaining power. “Larger work settings offer better conditions for contracting with third-party payers (89% of all physicians feel this way) whereas clinical autonomy was a valued feature of and more likely to be a feature of solo practices (81% of all physicians).”

Half of physicians think that their incomes will fall dramatically in the next three years and nearly 8 in 10 believe that “mid-level professionals will play a bigger role in direct primary care delivery” and that “insurers will aggressively negotiate to preserve margins....”

Physicians believing that doctors and hospitals will become more integrated in the next 1–3 years, by medical specialty

Physicians who believe that doctors and hospitals will become more integrated in the next 1–3 years, by medical specialty

Most satisfying element about practicing medicine

What keeps physicians going? Patient relationships and doing what they were trained to do: heal.

Most satisfying element about practicing medicine

Source: Deloitte 2013 Survey of U.S. Physicians

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.