John Marcille

The antihero Gordon Gekko doesn’t exactly whip out his cell phone in the 1987 film Wall Street. He hoists the Motorola DynaTac 8000X — nicknamed “the brick” — to his ear. Gekko is rich, for only the rich could afford “the brick,” which sold for about $10,000 in today’s money. See for yourself. Watch Wall Street at home on a flat-screen television set that sold for about $6,000 in 2004, but can be bought for $500 these days.

Which brings us to robotic surgery, the subject of our cover story. As author Richard Mark Kirkner explains, there’s no consensus that robotic surgery produces better outcomes across the board. Robotic prostatectomy is widely accepted as the standard of care for radical prostate removal, with results at least as good as (some argue better than) traditional open prostatectomy. However, the outcomes have not been so hopeful for other procedures, most notably hysterectomy.

Never mind. If you’ve got it, flaunt it, which is exactly what hospitals with da Vinci surgical robots do. They tell potential patients about their state-of-the-art technology because they believe in it. They also have to pay for it. The equipment can cost from $1.5 million to $2.1 million, not counting the expense of an additional operating room, contract service, and disposable tools.

Brent James, MD, executive director of the Institute for Health Care Delivery Research at Intermountain Healthcare, wonders what will happen if the shift toward fee-for-value continues, a shift that puts providers at more financial risk. No matter, says Marty Makary, a cancer surgeon, who predicts that “the technology will advance to where it will be a real tool for surgeons to have in their tray.”

Technology generates its own momentum, and certainly its own verbs. A few years ago, someone Skyped me. Not because she had information that could be relayed only visually, but just to show that she could.

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.