Only a small number of births occur outside the hospital, but the number has been rising lately, according to the National Center for Health Statistics (http://www.cdc.gov/nchs/data/databriefs/db144.pdf). “If this increase continues, it has the potential to affect patterns of facility usage, clinician training, and resource allocation, as well as health care costs,” says the study.

Out-of-hospital births for non-Hispanic white women are two to four times as prevalent as for any other racial or ethnic group. Again, we’re talking about a relatively small number: 35,184 babies were born at home in 2012, which was 0.89% of all births that year.

The American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics say that giving birth in a hospital or birthing center is the safest option.

However, women at higher risk of having problem deliveries — such as teen mothers, and women 35 or over — tend to go to the hospital. This perhaps suggests that physicians and other providers do a good job of outlining the risks to those patients considering having their babies at home, says the study.

Risk profile for out-of-hospital births, 2004 and 2012

Of all out-of-hospital births, the percentage in each of five risk categories

Source: “Trends in Out-of-Hospital Births in the United States, 1990–2012,” National Center for Health Statistics, March 2014

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.