It’s not exactly a matter of the cure being worse than the disease, but recent findings about diabetes and emergency department (ED) visits should at least give policymakers and clinicians pause.

The findings also ask: Just how should patients with diabetes who are 80 and over be managed?

Nearly 100,000 people wound up in the ED over five years because of mistakes made in diabetes treatment, most of it self-treatment, according to researchers at the Centers for Disease Control and Prevention. Those visits may have cost “well over” $600 million.

As the name suggests, the study in JAMA Internal Medicine, “National Estimates of Insulin-Related Hypoglycemia and Errors Leading to Emergency Department Visits and Hospitalizations,” looks at insulin-related hypoglycemia and errors (IHEs). The study took place from January 2007 through December 2011.

Patients ages 80 or older were more than twice as likely to head to the ED for IHEs as those 65 to 79, according to the study.

“Patients in the oldest group were also almost five times as likely to be hospitalized for IHEs as those 45 to 64 years,” the study states.

There were about 30,000 IHE-related hospitalizations in the five years.

Researchers point out that guidelines from such organizations as the American Geriatrics Society say that medications shouldn’t be used to achieve hemoglobin HbA1c control in most adults ages 65 or older.

The study states that “the high frequency and severity of ED visits for IHEs suggest careful consideration of hypoglycemic sequelae and a cautious approach when deciding whether to start or intensify insulin treatment among older adults, especially the very elderly.”

Of course, diabetes has everything to do with eating.

“Although meal planning is a well-recognized component of diabetes self-management education, the most commonly documented IHE precipitant in this study was meal-related misadventure, suggesting that further emphasis on meal planning in diabetes patient education efforts may be needed.”

The problem might very well be worse than the study suggests because “hypoglycemia, although a frequent cause of emergency medical service calls, is most often cared for outside the ED. Patients who have hypoglycemia unawareness and whose episodes do not result in EMS or ED care are not counted, nor are those who died en route or in the ED.”

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.