John A. Marcille

John A. Marcille

Harry S. Truman once said that the "only thing new in the world is the history you don't know," to which someone might flippantly rejoin that our plainspoken midcentury president had never had to program a VCR. However, Truman, if you recall, did wrestle with new technology — with the monster hatched by the Manhattan Project.

What would "Give-'Em-Hell Harry" make of electronic medical records, the focus of Contributing Editor John Carroll's cover story that begins on Page 24? The idea of putting patients' electronic medical records — their charts — on the Internet is reasonably new. The motivations that create the desire for this, however, could have been written about in Sanskrit: the need to communicate better, the desire to heal with more precision. What's not new about the technology are the questions it raises. How do we use EMRs? Do we use them at all?

Physicians, much to the chagrin of HMOs, seem to voice a resounding "nay" to the second question. So another new technology — the Internet — is now wheeled to the front to make the EMR technology more applicable.

Will this usher in the age of the EMR? We'll go out on a limb and say no, because it's less a matter of technology than of human nature. Physicians will not take the time nor make the investment necessary to throw their charts online. Are HMO executives listening? If they are, can they do something?

In this, health plans face the same hurdles in dealing with physicians that doctors face in dealing with noncompliant patients: How can you make someone do something without interfering with free will? Where does encouragement end and coercion begin?

"Man is condemned to be free; because once thrown into the world, he is responsible for everything he does," said the French philosopher Jean Paul Sartre. This country, it should be noted, has always considered freedom a blessing. Can physicians really be blamed for not being technologically up to date?

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.