Jan Greene

For years, Silicon Valley has been selling an enticing vision that technology, with its apps and wearables, would solve the problem of caring for an aging population and all of its expensive chronic illnesses. But while the ballyhooed devices meant to alert doctors of a dangerous arrhythmia and assorted other problems may be smart, they haven’t been very popular. The low-tech “I’ve-fallen-and-I-can’t-get-up” medical alert device that’s been around since 1989 remains the number one choice for vulnerable seniors.

Getting older people to bring a new technology into their homes has been more difficult than expected, and physicians don’t have time to process the information coming from multiple medical monitoring devices on their patients. Nevertheless, the tech industry continues to work on new options, and there are some intriguing possibilities on the horizon for 2017 and beyond. David Lindeman, director of the Center for Technology and Aging, a program of the Public Health Institute in Oakland, Calif., that evaluates and advocates for care technology, sees some of these as coming very soon—ingestibles that confirm a medication was taken, for example.

Amazon Echo

The popular tech gadget Amazon Echo has won praise for people with disabilities and their advocates.

Already on the market are devices such as the Amazon Echo, which allows the user to get information and control their home environment with voice commands. Sensors that detect when a person might fall are in development, Lindeman says, and driverless cars could be “a game changer” for frail elders who are no longer confident behind the wheel.

Certainly the problem of tracking the growing population of older, frail Americans isn’t going away. Most of the responsibility for the chronically ill lands on family members and other informal caregivers. According to an AARP report released in November, caregivers of family members have, on average, about $7,000 in out-of-pocket expenses each year. The gadgets aren’t free, of course, and cost is one of the reasons they haven’t caught on even if they might (it’s far from a sure thing) save caregivers time and money in the long run.

Smart technology will be coming our way, says David Lindeman of the Center for Technology and Aging. Ingestibles, for instance.

But as capitation grows and alternatives to hospitalization become ever more attractive from every perspective, health plans have a clear interest in finding low-cost solutions for the coming caregiving crisis, says Richard Adler, a distinguished fellow at the Institute for the Future, an independent research organization in Palo Alto, Calif. For devices to be more attractive to older people, though, they need to be introduced the old-fashioned way, according to Adler.

“There needs to be a human interface, a friendly helping hand,” he says. “There’s a pent-up demand among older people for technology, but it has to be met in a nonthreatening way.”

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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.