Ted Slafsky, MPP & Robert Chapman, MD

In an era of rapidly escalating prices, the 340B drug discount program remains one of the few checks to keep medicine and medical care accessible to the underserved. Contrary to the recent column, "Payers Must Develop Strategies To Overcome 340B Hurdles," it is not being exploited by participating hospitals.

If it were, where exactly is the money?

Paul Terry
President and CEO, HERO

 A few days ago, I went to the “Poke-stop” in my small town of Waconia, Minnesota, (population 11,490) to learn why I was losing my Pokémon “gym battles” and, more importantly, to survey the growing numbers of twentysomethings exploring my community’s parks and landmarks. I met a group of 15 Waconians for the first time, and they were excited about describing how Pokémon Go had increased their activity levels, their awareness of our community’s history, and their engagement with others.

Paul Terry

With the support of the Robert Wood Johnson Foundation, 35 of us visited the Lincoln Cottage, a hilltop retreat overlooking D.C. where Lincoln found solace, but also connected more closely with people, during the Civil War. Our group was there to inaugurate a national dialogue on health equity. Later dubbed the “Lincoln Cottage Assembly,” we were welcomed by health futurist Jonathan Peck at the staircase Lincoln climbed every day to write about the most vexing issue of his time.

Jonathan Gavras, MD
Chief Medical Officer, Prime Therapeutics

Our country is in crisis. We have an epidemic on our hands that crosses geographic boundaries, socio-economic status, gender, and many other categories. According to the American Society of Addiction Medicine, drug overdoses kill nearly 50,000 Americans each year. The media is certainly putting a microscope on it. Legislators are acting on it. Every stakeholder in the medical delivery chain is analyzing it–and I encourage physicians and other prescribers to take a look at their role in the problem.

Aiden Spencer
CureMD

Paper or plastic? Debit or credit? Netflix or Amazon? These are the kind of choices we are asked to make everyday. They are not, though, the type of decisions that keep us up at night.

Paul Terry
President and CEO, HERO
Lessons we’re learning from both companies and communities show that it takes a revolutionary mindset to advance a culture of health. Looking at the color of the food in your cafeteria just might be the best place to start.
Anand Natampalli and Daniel A. Schulte

Few examples highlight the differences between the analog and digital worlds as traditional taxi cabs vs. the ride-sharing company Uber.

Jan Greene

Among the nearly 42,000 people thronging the halls of the HIMSS meeting in Las Vegas this week are relative handfuls of folks from the nation’s health insurance industry. Presumably drawn by the increasing role of health IT in payers managing their members’ health and health costs, several companies were particularly prominent on the registration roster.

Kaiser Permanente has more than 300 people on the ground in Vegas, and has a booth set up in the exhibit hall showing off its Virtual Visits telehealth project featuring a faux doctor beamed in from New York.

Paul Terry, CEO, Heath Enhancement Research Organization
Paul Terry, CEO, Health Enhancement Research Organization

There are two transformations occurring in workplace based health promotion in America. The first is the movement from wellness to “well-being” and, related to this, a shift from a focus on a return on investment (ROI) to the use of value on investment (VOI) measures. These VOI measures are well documented and publicly available, but are we thinking broadly enough?

Paul E. Terry, PhD

Limiting access to any pleasures: tobacco, foods that are bad for you, the after-party of a Prince concert—you name it, you’re going to be unpopular with many people.  To quash what some see as their right and none of your business is to invite endless arguments that as often as not have little to do with the facts of the matter.  As someone who has weighed in on my share of health policy debates, I’ve long observed that the “greatest good for the greatest number” bromide calms my nerves, but it seldom holds sway with those who don’t see what good the policy is doing them.  

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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.