When is a cancer not a cancer? When it can be described as a “subclinical disease,” according to a study in JAMA Otolaryngology — Head and Neck Surgery (http://jamanetwork.com/journals/jamaotolaryngology/fullarticle/1833060). That’s just one of the solutions researchers offer to what they call an epidemic in thyroid cancer diagnosis. They suggest “relabeling incidentally identified small thyroid neoplasms, reclassifying them using a term other than cancer.”

Incidence of the disease tripled since the 1970s, while mortality rates have remained relatively stable. Most of the diagnosis has been for papillary thyroid cancer, a non-aggressive form that hardly ever threatens life, according to the study. “Unfortunately, our findings on current treatment patterns suggest that most thyroid cancers are still being treated as though they are destined to cause real problems for the people who have them.”

Most of the increase in diagnosis has been in women. “This is particularly notable because thyroid cancer prevalence at autopsy is actually greater in men than it is in women,” the study says. “This suggests that the problem of thyroid cancer overdiagnosis in women has probably been present for decades.”

Eighty-five percent of people diagnosed with thyroid cancer have total thyroidectomy, and not only are they at risk for postoperative complications, but they will need thyroid hormone therapy and monitoring for the rest of their lives. Providers “need to be asking themselves whether they are looking too hard for thyroid cancer. Patients — and in the case of thyroid cancer, particularly women — need protection not only from the harms of unnecessary treatment but also the harms of unnecessary diagnosis.”

Thyroid cancer incidence and mortality, 1975–2009

Thyroid cancer incidence by histologic type, 1975–2009

Thyroid cancer incidence and mortality by sex, 1975–2009

Source: “Current Thyroid Cancer Trends in the United States,” JAMA Otolaryngology — Head and Neck Surgery, Feb. 20, 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.