Telemedicine works in intensive care units (ICUs), no matter the size of the hospital or the region where it’s located, according to a huge study of the technology’s effectiveness. The study, published in the journal Chest, tracked about 120,000 patients from May 2003 to December 2006 in 56 ICUs, 32 hospitals, and 19 health systems.

“The large size of the study and its finding that improvements in performance were not limited to a single type of ICU, size of hospital or community served, hospital teaching status, or U.S. region suggests that these findings are broadly, rather than narrowly, applicable,” the study states.

Telemedicine allows critical care teams — which may be hundreds of miles away — to alert ICUs the minute a patient takes a turn for the worse.

The study found that patients monitored by telemedicine were:

  • 26% more likely to survive the ICU
  • Discharged from the ICU 20% faster
  • 16% more likely to survive hospitalization and be discharged
  • Discharged from the hospital 15% faster

“The association of the ICU telemedicine interventions with lower hospital mortality is notable because prior studies have not had adequate power to provide unequivocal evidence of this association,” says the study, “A Multicenter Study of ICU Telemedicine Reengineering of Adult Critical Care.”

For patients who stayed seven or fewer days, stays in the ICU were reduced by 0.5–1.1 days, thanks to telemedicine. The technology reduced by 1–2.5 days the stay for patients who were in the ICU 14 or fewer days. For patients who stayed 30 or fewer days, the reduction was 3.6–4.5 days.

A day here and a day there and pretty soon you’re talking about real money: Critical care costs the nation from $80 billion to $100 billion a year.

“Improved outcomes were primarily attributable to earlier intensivist management, coordinated timely usage of performance information, achievement of higher rates of adherence to best practices, shorter alarm response times, more frequent interdisciplinary rounds, and a more effective ICU committee,” the study states.

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.