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Biosimilars for Rheumatoid Arthritis: Don’t Count Them Out Quite Yet

Because physicians and health plan members both value choice, the current weak market for Inflectra and Renflexis could be a passing phase. Attitudes could change once there is more data that show people do well after switching from Remicade to the newcomers.

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The CVS Effect on American Health Insurance

Once they have the right platforms in place, insurers can layer on predictive analytics, digital medical records, and other innovations that promise to make health care costs more manageable—and in the process make health insurers more competitive with the likes of CVS and maybe, eventually, Amazon.

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Is CAR-T Really Putting Us On Road to Gene Therapy?

Some say gene editing platforms like CRISPR are a truer version of gene therapy because they are designed to home in on a particular genomic location.

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Prior Authorization: Do Insurers Pay Bonuses for Denying New-Drug Requests?

A MedPage Today blog post suggests that they do. Industry veterans say they’re unaware of bonuses for denials but agree prior auth processes should be more transparent.

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Harvard Pilgrim’s Patrick Cahill Tries To Make Sense of It All

The 40-year-old has to guide one of the health insurer’s regional markets as the ACA continues to evolve. His course? Keep strengthening ties with providers.

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Purchasers to Insurers: Standardize Your ACO Measures

Building on a similar effort in California, Catalyst for Payment Reform is proposing a standardized set of 50 ACO measures. Some of the country’s largest purchasers are taking it to their health plans.

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Real-World Evidence Not Quite Believable Enough 

In theory, this approach could help untangle some knotty cost and quality concerns about medications as they move from clinical trials and into clinical use. But there’s that credibility issue.

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3 Social Determinants Strategies

A look at three different approaches that seek to address social needs in a strategic and somewhat comprehensive way. At this point, all of them are experiments, and no one knows which will prove to be sustainable, replicable, or even beneficial to the patients and communities they seek to serve.

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Management Partnerships (‘ACO Enablers’) Are Pervasive Part of ACOs

In theory, ACOs are groups of providers that band together to lower the cost of health while maintaining its quality by using various tools in the value-based care (aka population health) toolkit: care coordination, data analytics, avoidance of low-value services. But a study published in this month’s…
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Social Determinants of Health: Stretching Health Care’s Job Description

Providers and payers are being asked to tackle the ‘upstream’ causes of poor health. Medicaid managed care organizations are being asked to screen enrollees for social needs. Some targeted efforts have translated into cost savings and make sense in value-based arrangements. But are we asking the health sector to take on too much?

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A 12-step Program for American Health Care

Ezekiel J. Emanuel’s Prescription for the Future is true to its title and proposes a five- to 10-year agenda for transforming expensive, wasteful American health care into a system that delivers high-value care. This is a qualitative book based on case studies that identify and systematize how to improve quality, patient experience, and cost.

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Diabetes Costs Employers $20B in Unplanned Sick Days

That’s thanks to about 57 million unplanned sick days for workers. The prevalence of diabetes in the adult population grew from 10.6% in 2008 to 11.6% in 2016. It was at 11.5% for the first nine months of 2017.

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Interoperability of Electronic Health Records: A Physician-Driven Redesign

The document “Feature and Function Recommendations To Optimize Clinician Usability of Direct Interoperability To Enhance Patient Care” offers recommendations from the clinician point of view. Widespread adoption of even a few of these recommendations by designers and vendors would greatly enhance care.

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Health Care Resource Use and Costs Pre- and Post-Treatment Initiation With Linaclotide: Retrospective Analyses of a U.S. Insured Population

As expected, pharmacy costs increased with the introduction of this new treatment in a market dominated by over-the-counter and generic treatments. On the other hand, outpatient GI-related and irritable bowel disease health care resource use and costs substantially decreased among commercial and Medicare patients following linaclotide treatment initiation.

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Three Flavors of Oral Health Care

Training primary care physicians to identify and treat oral health problems will go a long way toward integrating care for those problems with general medical care, according to a study in the Journal of the American Board of Family Medicine.

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