David Hanekom, MD, and Steven Udvarhelyi, MD, are two former medical directors who became CEOs. Their new job means really understanding the business side of health care, the need for healthy members, and a healthy bottom line. But it also means watching costs and keeping stakeholders —which can include stock holders—happy.
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.
The disease is endemic in Latin America, where an estimated 8 million people are affected. It is a lifelong illness and, if untreated, it can result in life-threatening health conditions. Enter benznidazole, which shows we can respond to these new threats in both a medically and an economically responsible manner.
Some experts say that investors funding innovative startup companies can disrupt American health care, making it smarter and more efficient. Others warn that incentives must change if VC money is to make a real difference. It’s a trend no one in health care can ignore.
With regulations limiting differentiation between products, health plans must rethink consumer experience to meet expectations of today’s consumers, who seek convenience, quality, and speed from their health care organizations. Many plans understand they need to connect more effectively with their end customers, but technological, cultural, and other obstacles are in the way.
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.
Insurers are playing “small ball” and not showing leadership, says the former congressman. And some “spin-dry” inpatient providers are doing more harm than good in combating the opioid epidemic. Meanwhile, Kennedy, who chronicled his own harrowing mental health and addiction struggles in a 2015 memoir, says he has been sober for more than six years.
For all the sturm und drang, experts foresee neither a hurry-up nor a halt for 2018, just a fairly steady continued rise at roughly last year’s higher-than-inflation pace. The Drug Price Forecast, for example (based on hospital and nonacute settings, but not retail pharmacy), reports that that means a tidy year-over-year increase of 7.61%.
How the world looks depends on your point of view. Medical directors, some with experience as payers and providers, share their thoughts on prior authorization, value-based care, and quality measurement. One opportunity: Payers should work with specialty organizations and physician advocates to develop metrics and processes that make sense from the physician perspective.
PBM consultant Linda Cahn says that if Amazon gets into the PBM business it could insist that drugmakers simultaneously submit the net discount price for each of their drugs for the subsequent six months. Amazon could then publicize every drug’s actual price, by drug and by therapeutic category.
Study results showed a modest (12%) advantage for the care management group in control of blood sugar levels, as measured by the proportion of patients whose HbA1c was under 7%. Among the obese patients, the care management group had a 16 percentage point edge (26% vs. 10%) over the usual care group in the proportion of those who lost 5% of their body weight.
Population health should be about collective societal benefits like disease prevention and better health—better behavioral health included. Substantial investment is admittedly hard to make with no line of sight on where and when the cost benefits will come. It will take a leap of faith. Are you ready to jump?
For instance, say something a patient needs is not covered by Medicaid or an ACA plan. Blanco helps members find what they need by working with Molina’s Community Connectors (community health workers) who help connect members to local community and not-for-profit organizations.
The author’s nephew suffers from a rare form of familial hemophagocytic lymphohistiocytosis. His organs shut down and he’s placed in a medically induced coma. Meanwhile, costs mount to $4.9 million, most of it paid by an employer-sponsored health plan.