Timothy Kelley
MANAGED CARE September 1997. ©1997 MediMedia USA

Timothy Kelley

Some readers no doubt come from families where medicine is a tradition. I hail from humbler stock: a family full of journalists. In 1966, when I was 16, I woke up one morning to see on page one of the Chicago Sun-Times a photograph of my dad with his arms around a woman who was not his wife. And oddly, my mother seemed proud about it.

My late father, Robert W. Kelley, was a staff photographer for the weekly Life magazine. He had been assigned the ongoing story of a New Jersey truck driver's attempt to break the world's free-fall record by jumping from an airplane and then waiting perilous minutes before activating a balloon that would slow his descent. In a morally questionable project, Life was collaborating with daring jumper Nick Piantanida, outfitting him with remote-control cameras (which my father set up, with special tape to protect them against high-altitude cold), and in effect encouraging him to risk his life. On his third try, as a Life column headline explained, "The Cameras Worked, But the Balloon Failed." Piantanida ended up in a coma. And my dad appeared in an Associated Press photo embracing Piantanida's wife over a caption that said she was being "comforted by a family friend." At that moment, Life's need for a picture of the grieving wife came second, and my father was a human being first.

As troubling as Life's participation in that venture may seem to some, photojournalism has become even more controversial in the years since. And the line my father drew — the line that says, "Here the zeal to record stops, and compassion begins" — is becoming as hard to discern as the original shape of a certain Mercedes in the Paris night.

We pose a different issue about journalism in the article where a New York Post reporter tells how he came to prepare an investigative series with headlines such as "Managed Care Casualties Enough To Make You Sick." The press must — and should — appeal to emotion. But where are the boundaries of fairness?

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.