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.

And they can pull them right back out again, changing their minds in the coming months and not participate in the ACA exchanges, according to the Wall Street Journal. It’s a struggle for health insurance officials, making this decision about should they stay or should they go.

Viewpoint
Zachary Hafner
It’s going to take a lot of work. The good news is that great progress is already being made. As technology and consumer expectations continue to evolve, we can expect virtual care to play an increasingly important role in ushering in truly integrated care.

UnitedHealthcare made a very public exit from many state Obamacare exchanges last year, scaling back its participation from 34 to just three states.

The debate over just what a pharmaceutical company can say about off-label use of its medications pits free speech rights against the FDA’s mission to protect the public, STAT reports. A bill introduced by Rep.

Q&A
Interview by Peter Wehrwein

Henry DePhillips
Teladoc

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.”

Buried within a New York Times article about the costs of nonadherence to prescribed medication—in both financial and human terms—resides yet another argument for value-based health care. Nonadherence “partly explains why new drugs that perform spectacularly well in studies, when patients are monitored to be sure they follow doctors’ orders, fail to measure up once the drug hits the commercial market.”

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….”
Timothy Kelley
Robert Chalfant, MD, of Colorado West Mental Health, says a large part of his practice involves video sessions conducted over the internet. Telemental health means less driving and fewer canceled appointments because of bad weather.
One area where more research is needed is on programs that mix telemental health with traditional treatment, because in many instances a combination of the two will work better than a steady diet of either. The use of telemental health as an alternative or a backup needn’t be saved for emergencies.
Richard Mark Kirkner
Antibiotic overuse? Ateev Mehrotra, MD, of Harvard Medical School, found that primary care physicians were more inclined to prescribe antibiotics for sinusitis and urinary tract infections when they performed an e-visit compared with patients they saw in the office for the same conditions.
Evaluating the quality of telemedicine care is about as easy as evaluating the quality of health care, period, and researchers are still ironing out the methodological kinks. That may be one reason research results are all over the place. This article involved reviewing nine such studies, and the findings are a mixed bag.