The Centers for Disease Control and Prevention estimates that 1 in 10 adults in the United States has diabetes. That number is expected to rise to as much as 1 in 3 by the middle of this century if current trends continue. All the increase could be attributed to type 2 diabetes, which is largely preventable.

In the chart, researchers used “person years” rather than just “years” because it handles situations where the amount of observation time differs between people, or when the population at risk varies with time.

The agency cites the aging population, increases in minority groups that are at high risk for type 2 diabetes, and even the fact that people with diabetes are living longer with the disease. These projections are higher than previous estimates because they factor in aging, minority populations, and lifespans.

The CDC and health plans should be worried.

“These are alarming numbers that show how critical it is to change the course of type 2 diabetes,” says Ann Albright, PhD, RD, director of the CDC’s Division of Diabetes Translation.

Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, says, “These numbers are worrisome. But health plans have pioneered programs that promote wellness and healthy living. They are well positioned to help patients who are suffering from diabetes and they see a patient’s entire interaction with the health care system — they see every doctor visit and they see every prescription that gets filled.”

Projected incidence of diabetes through 2050

Historical incidence rates range from 3.3 cases per 1,000 in 1980 to 7.8 in 2007. The middle incidence scenario increases steadily from 8.4 in 2008 to 14.7 in 2050. The cumulative incidence is the number of new cases within a specified time period divided by the size of the population initially at risk.

Projected incidence of diabetes through 2050

Source: Boyle JP, Thompson EJ, Gregg EW, Barker LE, et al. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. 2010. Pop Health Metrics. 8:1–33.

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.