The five leading causes of death are heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries, according to the Centers for Disease Control and Prevention. A study in the CDC’s publication Morbidity and Mortality Weekly Report (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6317a1.htm?s_cid=mm6317a1_w) says that these five causes were responsible for 63% of deaths in 2010 and that the next five were responsible for about 12%.

Many of the deaths from the five leading causes are preventable. “If all states achieved the lowest observed mortality levels for the five leading causes, when considered separately, as many as 91,757 premature heart disease deaths, 84,443 cancer deaths, 28,831 chronic lower respiratory disease deaths, 16,973 stroke deaths, and 36,836 unintentional injury deaths might be prevented each year,” the study states. “These calculations translate to approximately 1 in 3 premature heart disease deaths, 1 in 5 premature cancer deaths, 2 out of 5 chronic lower respiratory deaths, 1 out of every 3 stroke deaths, and 2 out of every 5 unintentional injury deaths that could be prevented.”

But just how to do this? The study recommends screening, early intervention, successful treatment, and reducing risk factors. Risk factors for heart disease are, for instance, smoking, high blood pressure, high cholesterol, type 2 diabetes, poor diet, being overweight, and lack of physical activity.

The mortality data are from the National Vital Statistics System for 2008–2010. The calculations are for U.S. residents up to age 80.

Annual number of deaths observed and potentially preventable* for the 5 leading causes of death for persons up to age 80 in the United States, 2008–2010

*Expected deaths are the lowest three-state average, age-specific death rate, multiplied by the age-specific state population rounded to the nearest whole number. Potentially preventable deaths are observed deaths minus expected deaths rounded to the nearest whole number.

Source: “Potentially Preventable Deaths from the Five Leading Causes of Death – United States, 2008–2010,” Morbidity and Mortality Weekly Report, May 2, 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.