You bet they do. Are they fulfilling that role? You bet they do not. The Centers for Disease Control and Prevention calls this the world’s most pressing public health threat. Insurers’ track record in ensuring proper use of antibiotics has been abysmal. Improvement is possible, and necessary.
Fostering appropriate use of antibiotics is one step, but there’s much more that insurers can do, starting with eliminating health care-associated infections in the first place. Hand washing works in stopping the spread of infection. How many health plans track how well hospitals enforce hand-hygiene rules?
In these early days everything is in flux, but accountable care organizations (ACOs) will need to manage pharmacy in order to help reduce the big-ticket episodes of care. A lot will depend on whether the risk for medical and pharmacy spending remain separate. Some experts see that as unsustainable.
You want an end to gridlock? Just try messing with the government drug program. That’s just what happened when the CDC proposed new rules. “It’s hard to unite everybody in town around one position on a health policy,” says one expert.
Independence Blue Cross and Aetna are among the insurers who’ve opened special centers dedicated to finding better ways to deliver care. They’ve joined with providers to develop better delivery systems. After all, the incentive models today have been grandfathered in, and a lot has changed since grandfather’s day.
The implementation of the Affordable Care Act is expected to push the FDA into issuing a final rule, and several states have already considered the issue of biologic substitution. The cost advantage is incontrovertible, but will doctors and patients join reference product manufacturers in trying to restrict them?
The days of interferon and its harsh side effects are not quite over for a subset of people with HCV. Two manufacturers race to usher in a new age of treatment; one a three-drug cocktail for patients with genotype 1 HCV; the other a fixed-dose combination for the same patients.
Robert Royce, PhD
Average ED income per patient in one hospital was $184
Pill hoarders, doctor shoppers, and just plain addicted patients are a growing problem for physicians — and thus for health plans, too
Both payers and providers benefit
Adasuve helps people with bipolar disease or schizophrenia recover from an intense state of agitation