Timothy P. Search, RPh

Most technological changes in publishing go on behind the scenes. A patient may find himself swallowing a new pill, or stretched out in some novel imaging machine, but a magazine reader sees the same magazine, more or less, that he saw years ago. New printing technologies, improved tools for designing pages, advances in how we gather information — these are not obvious, but they have been evolving in the background.

Now for some foreground action: We have just introduced a new, additional format for Managed Care. It looks just like the familiar one, but you will experience major differences. It is our digital edition. The print edition is not going away; it will remain just as you know it. But there are good reasons to prefer the electronic edition, which makes use of Nxtbook technology and has many conveniences for the reader:

  • Click on any URL anywhere in the magazine and go directly to that Web page
  • Click on the title of any article on the cover or in the table of contents and go directly to that article
  • Search for any string of characters
  • Make and save notes with the article that you are reading
  • Instantly e-mail links to any article to an associate to read
  • Get more information about advertised products by clicking on an ad
  • Save the magazine file to your desktop for offline reading
  • Print any or all pages

Since the mid-1990s, we have posted our articles on our free Web site, www.managedcaremag.com. Anyone may visit that site and view an html version of any article. But the new edition is different from our archives. You view a complete copy of an issue on your computer screen, and it looks just like the magazine. In fact, the production process is exactly the same. We prepare special high-resolution files for our commercial printer, and we also give those files to Nxtbook, which converts them into the digital edition. Why not take advantage of this neat technology?

Speed and convenience

You can still turn pages one by one, as with the printed magazine, but we make extensive use of hyperlinks. After you register (free) for the electronic edition, you will get a monthly e-mail message with a link to the new issue. If you want to try it out right now, open www.managedcaremag.com/digital. You’ll have to copy that link into your browser, so we made it short.

Here’s something you can do you would never do with the printed magazine: Search through every single word in the issue for something. Does this issue have anything on WellPoint, imaging, Pfizer, or disease management? You’ll know in an instant.

Or you are reading an article on physician income and you encounter a long, long Web address in a reference — and you know how long they can be. You might not make the effort when reading the physical magazine, but with MANAGED CARE’s digital edition, just click and be transported to the Web page. No effort, no lost time, no irritation.

I hope you find this new edition as reader-friendly as I do.

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.