John A. Marcille

John A. Marcille

We've come down foursquare for the Anglo-English alliance this month, as two of our stories show that we can still learn a thing or two from our older British cousins. Our cover story on movement toward a national EMR system compares what's going on here to how a similar effort is being undertaken in the U.K.

There, the impetus for change is the frustration created by long lines leading into providers' offices. We want better efficiencies here, as well, but are equally focused on cost control. Maybe more than equally.

"Whether it works or not won't be known for some years, but tech experts here in the United States are clearly envious of some advantages the British have in pushing adoption," Contributing Editor John Carroll writes of the U.K. effort.

Then we look at what might be gained by the FDA's pending ruling on OTC low-dose statins. An FDA approval would follow a similar change in the U.K.

Earlier this year, low-dose statins went OTC in the U.K. when Merck's Zocor was approved for what is known there as "behind-the-counter" status. That means that when a consumer wants OTC Zocor, he needs to ask the pharmacist for the drug and is counseled on its benefits and risks. Even with the behind-the-counter restriction, which we of course don't have here, the move had its critics.

Still, it's worth noting that, as we seek to recover from a bruising election, we still gain some knowledge and inspiration from those folks whom we rebelled against over 225 years ago and who made our elections possible.

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.