A third of Americans ages 50 to 70 — about 23 million people — have never been screened for colorectal cancer, according to the Centers for Disease Control and Prevention.

This is despite the consensus that screening saves lives.

The U.S. Preventive Services Task Force recommends screening with colonoscopy every 10 years, or sigmoidoscopy every five years, or fecal occult blood test every year for patients who are not at risk.

CDC Director Tom Frieden, MD, says that the main reason people are not screened is that their doctors forget to recommend it. That’s unfortunate because, as the study says, “Primary care providers are the most common source for a CRC [colorectal cancer] screening recommendation.”

Colorectal cancer kills about 50,000 people a year, making it the leading killer of nonsmokers.

The study “Vital Signs: Colorectal Cancer Screening Test Use — United States, 2012” (http://tinyurl.com/CDC-screening-study) was in the agency’s Morbidity and Mortality Weekly Report on November 9.

Not surprisingly, people who don’t have health insurance are less likely to be screened (about 37% of non-insured are screened). Coverage does not mean compliance, though.

The study states that “among those who had never been screened, 76% actually had health insurance, so additional interventions are needed even among those with access to health care.”

The CDC would like to see an outreach effort similar to the ones for “immunization and screening for sexually transmitted diseases, [which] have been successful in substantially increasing CRC screening in several settings.” The report cites a recent study in which mailing reminders to patients who needed to be screened increased screening rates.

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.