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.

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.