News & Commentary
Pharmaceutical manufacturers take their cues from insurers and physicians who want medications that thwart the progression of MS and prevent or at least lessen the intensity of relapses. But patients are also concerned about out-of-pocket costs and dangerous but rare side effects.

The only thing that’s certain these days in health care is uncertainty. House Speaker Paul Ryan announced today that the spending bill currently being ironed out by lawmakers will not include payments to insurers, reports the Wall Street Journal.

News that Anthem, the second largest health insurer in the country, will not renew its contract with Express Scripts, the country’s largest PBM, rocked the industry yesterday.

News & Commentary
Molina Healthcare showed a net loss of $47 million in the fourth quarter of 2016 compared with a $30 million profit in the fourth quarter of 2015. CEO J. Mario Molina blames what he considers a structural flaw in the ACA known as the risk transfer.

Micro-hospitals are finding their niche in the health care system, says U.S. News & World Report. The facilities provide about 10 beds for short stays and can treat some of the less emergent emergency services usually done at large hospitals.

Use of statins to prevent the recurrence of a heart attack after the first such incidence is a generally accepted practice guideline, but its effectiveness is muted because of nonadherence, according to a study in JAMA Cardiology.

Medical Directors Forum
Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD

Richard G. Stefanacci, DO

As American health care shifts from the fee-for-service, disconnected health care to value-based, holistic care, an alignment between providers and total cost of care should encourage the use of telemedicine—especially in cases where it has been shown to reduce costs and improve individual care and population.

Some states have established programs, mostly dependent on reinsurance, in an effort to make Obamacare more palatable for already skittish insurance plans, the Wall Street Journal reports.

Book Review
Peter Boland
From Obamacare to Trumpcare: Why You Should Care by Harry Nelson and Rob Fuller challenges the policy of both Democrats and Republicans. It explains how our country is so ideologically polarized that a consensus on health care is unlikely to emerge for the foreseeable future.

Lessons abound in the story about Glybera, a gene therapy developed by the Dutch biotech company UniQure to treat a very rare disease, but one stands out: Good luck getting insurers to cover a treatment that costs $1 million for a one-time dose and that helps only a miniscule number of patients.

Legislation & Regulation
Richard Mark Kirkner

Latoya Thomas
American Telemedicine Association

If millions of Americans lose Medicaid or private health insurance coverage because of the unACAing of American health care, telehealth may seem like a gimmicky sideshow rather than a good-faith effort to bring health care into the digital century.
Interview by Peter Wehrwein

Henry DePhillips

The CMO of Teladoc, one of the country’s largest telemedicine providers, certainly knows how to sing the praises of the industry, and handle devil’s advocate kind of questions as well. Most of Teledoc’s customers are commercial insurers and employers. Medicare? Not so much. Medicaid makes “perfect sense.”
News & Commentary
High drug costs are a cause célèbre. Executives at Harvard Pilgrim Health Care have responded with value-based contracts for two expensive medications, etanercept (Enbrel) and teriparatide (Forteo). Michael Sherman, MD, Harvard Pilgrim’s chief medical officer, said in the news release that “real world performance of new medicines frequently differs from the well-controlled clinical trial setting….”