We reported last month on the seriousness of the problem of antibiotic-resistant bacteria (http://bit.ly/1hMgxTa). That problem affects all ages.

Most children (77%) are resistant to three or more antibiotics usually used for extended-spectrum beta-lactamose (ESBL)-producing enterobacteriaceae infections. This, according to a study in the Journal of the Pediatric Infectious Diseases Society.

Researchers conducted a case-case-control study of children ages 0 to 17 from 2008 to 2011, and note that the multidrug resistance presents a clinical care challenge.

“This drastically limits therapeutic options, particularly for oral drugs,” the study stated, adding that there are no clear-cut guidelines specifically aimed at children because “most antibiotic clinical trials for ESBL-producing infections are in adult populations.”

Most of the infections in the children (60%) are found in the ICU, though 30% occurred in outpatients.

“We found that the main risk factor for ESBL infection in children was having a neurologic comorbidity and that the majority of infections were multidrug-resistant,” the study stated. Other risk factors included chronic conditions, prior immunosuppressive therapy, and prolonged hospital stays.

“ESBL infections are increasing dramatically across the globe,” the study stated.

Latania K. Logan, MD, the study’s corresponding author, offered the opinion that health insurance plans should be concerned about this problem because “some infections in children that have typically been treated with oral antibiotics in the past may now require hospitalization and/or treatment with intravenous drugs as there may not be an oral option.”

Logan adds that one of the best ways insurers can help providers is by encouraging physicians “to obtain cultures for suspected bacterial infections so that laboratories can determine which antibiotics are best to treat infections.”

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.