Infectious diseases are, unfortunately, making a comeback, and pharmaceutical manufacturers hope to address the problem. There are 394 drugs in the pipeline to fight these diseases, according to the Pharmaceutical Research and Manufacturers of America (http://tinyurl.com/infect-disease). In development are 226 drugs for viral infections, 124 for bacterial infections, 24 for fungal infections, and 15 for parasitic infections. . . . Nearly 3 of 5 patients at risk of losing their eyesight as a result of diabetes do not recall being alerted by their physicians to the danger, according to a study in JAMA Ophthalmology (http://tinyurl.com/opth-study). The problem can be easily treated, say researchers, but doctors can’t treat what they don’t know exists, and the best early warning system is patient feedback. . . . Patients may obtain their test results directly from the laboratory rather then wait for them to be filtered through treating physicians in hospitals or private practice, according to a new ruling by the Department of Health and Human Services. . . . Emergency department doctors brace for an influx of patients thanks to the Affordable Care Act — an influx they say that they’re not at all ready to handle (http://tinyurl.com/story-ED). The American College of Emergency Physicians gives the nation a “D+” in terms of how hospitals will be able to handle the demands that health reform will present. . . . Simplified dosing for HIV patients leads to better adherence and virologic suppression, according to a study in the journal Clinical Infectious Diseases. The study also says that there isn’t much difference between once- and twice-daily dosages. Researchers conclude that dosage modification is only one way to boost adherence. . . . The idea that engaged patients will have better outcomes is challenged in a study in the British Medical Journal for Quality and Safety (http://tinyurl.com/engaged-patients). One of the problems is defining just what patient engagement means. “Definitions of patient and family engagement were lacking, as well as evidence regarding the types of patients who might feel comfortable engaging with providers, and in what contexts,” the study says. . . . Mental health patients are 4 to 16 times more likely to have HIV than the general population, according to a study in the American Journal of Public Health (http://tinyurl.com/Phil-Balt-study) that tracks about 1,000 patients who sought mental health treatment in Philadelphia and Baltimore. Researchers say the findings illustrate the need for routine HIV testing in mental health facilities. . . . Yet more doubt thrown on the benefits of vitamin C and E supplements. In some cases they actually reduce the benefits of exercise, according to a study in the Journal of Physiology (http://tinyurl.com/vit-study). The study looked at 54 men and women who were already in pretty good shape. Most were runners or cyclists. Half got a placebo; the other half got the vitamins. After an intense 11-week training program, both groups showed improvements but the one taking placebo had more energy and better health. . . . There’s an epidemic in thyroid cancer — but it’s an epidemic in diagnosis, not disease, according to a study in JAMA Otolaryngology–Head & Neck Surgery (http://tinyurl.com/thyroid-study). Incidence of the disease tripled since the 1970s, but mortality rates remain the same. A less aggressive form of the disease is being found and treated.

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.