The number of people with atrial fibrillation (AF) will more than double in the next two decades, growing from about 5 million in 2010 to 12 million in 2030, according to a study in the American Journal of Cardiology. This can be pinned partly on the aging population “but also reflects the empirical fact that the incidence rate of AF is increasing,” the study states. The authors say that the higher prevalence might be a matter of better methods used to detect hypertension. They also cite increased risk factors, such as obesity and diabetes.

The study reviews a database of 14 million people enrolled in large commercial health plans and Medicare Advantage plans between 2001 and 2008. “The age- and gender-adjusted AF incidence rate, standardized to the general U.S. population, grew from approximately 220 per 100,000 in 2002 to about 350 per 100,000 in 2007… corresponding to a 9.2% annual growth rate.”

The authors concede that while the AF rate will certainly increase, “there exists a wide range of uncertainty around the magnitude of future trends,” and it could fall between 7.8 million and 17.7 million by 2030.

Projections of future prevalence of atrial fibrillation

Projections of future prevalence of atrial fibrillation

Probabilistic range of uncertainty around the projected AF prevalence estimate for sensitivity analysis by simultaneously varying all the input parameters used in model. The probabilistic range of AF prevalence estimates is represented by the upper 10% likelihood (blue dashed line) and the lower 10% likelihood estimate (green dotted line) around the base AF prevalence estimate with logarithmic incidence growth rate projection (purple solid line).

Source: Am J Cardiol. 2013 Jul 4. pii: S0002–9149(13)01288–5. doi: 10.1016/j.amjcard.2013.05.063.

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.