Many patients facing the prospect of having knees or hips replaced use the “I can’t live with this pain anymore” method of making the decision. That is, they put it off until they can’t put it off any longer. Thanks to work by researchers at Duke University, knee-replacement operations might become a thing of the past (http://tinyurl.com/knee-cart). They are trying to create artificial joint cartilage. Better for patients and, hopefully in time, better for cost management.... Black women are much more likely to have high blood pressure than black men or white men and women, according to a study in the journal Circulation: Cardiovascular Quality and Outcomes. The study looks at about 70,000 people in the southeastern United States, a.k.a. the “stroke belt.” The overall rate of high blood pressure is 57%, but it’s 64% for black women.... Patients at high risk for lung cancer will be able to get low-dose computed tomography (LDCT) screening without being charged a copayment or a deductible, thanks to a ruling by the U. S. Preventive Services Task Force. The task force gave LDCT a B recommendation. High-risk patients are people ages 55 to 80 who have smoked at least 30 packs of cigarettes a year, and former heavy smokers who have not smoked for 15 years.... Researchers tracking about 6,500 women ages 65 to 79 in the United States find that those who have a history of heart disease had nearly a 30% increase in developing cognitive difficulties than women without heart problems, according to a study in the Journal of the American Heart Association (http://tinyurl.com/heart-dementia). Many types of heart disease and vascular disease are associated with declining brain function.
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.
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?
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.
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.