Every year, about 759,000 children with asthma are at risk for an attack while they have no insurance, according to an analysis of data from the National Survey of Children’s Health.

About 30 percent of those families earn more than 200 percent of the federal poverty level, putting them above the threshold for the State Children’s Health Insurance Program (SCHIP) in most states. Studies have shown that providing insurance to children with asthma through SCHIP reduces their unmet needs and reduces racial disparities in access to care.

“These children need to have ongoing treatment from a primary care provider to avoid serious health complications. Without that, they are at increased risk for ongoing symptoms and even hospitalization,” says Jill Halterman, MD, MPH, lead author of the paper, which appeared in the journal Ambulatory Pediatrics.

In addition, about 13 percent of children with asthma were without insurance at some point during the year. That includes 2 percent of children who were uninsured for the entire year. This amounts to 114,000 children who were 14 times as likely to have had an unmet need for medication than were children with private insurance. Even those who were covered by the time of the survey were six times as likely to have missed out on needed medication.

No differences were found between children with private and public insurance when it came to unmet needs, discontinuity of care, or poor access. This suggests that consistency of coverage for children with asthma is more important than the source of insurance.

The researchers also found that many children with asthma were not seeing a primary care physician often enough. Almost one-third of parents of uninsured children said they had no personal primary care doctor for their child.

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.