The cumulative costs of care for people with Alzheimer’s disease will exceed $20 trillion (today’s dollars) from 2010 to 2050, assuming the absence of disease-modifying treatments (therapies that affect the disease, rather than just the symptoms). These daunting data are presented in the Alzheimer’s Association’s “Changing the Trajectory of Alzheimer’s Disease: A National Imperative.” The report also shows that the number of Americans age 65 and older who have this condition will increase from the 5.1 million today to 13.5 million by the middle of the century.... “Workers appreciate the value of the health care coverage their employers offer to them and their families,” says the National Business Group on Health’s president, Helen Darling. But more than a third would consider dropping that coverage if cheaper but similar coverage were to become available through other avenues, according to a survey conducted jointly by the NBGH and Hewitt Associates, involving more than 3,000 American workers. The survey found that 61 percent of Americans use employer-sponsored health care coverage and participate in healthy living and wellness programs. Nearly half plan or hope to continue to do so in the next three to five years.... Osteoporosis screening increased to 64 percent for women age 65 and over, according to the latest numbers in the “2009 National Healthcare Disparities Report” from the Agency for Healthcare Research and Quality (AHRQ). Back in 2001, it was only 34 percent. Two-thirds of the estimated 34 million Americans at risk of developing osteoporosis are women. The latest numbers from the agency indicated that Hispanic women had the most dramatic increase in screening, going from 22 percent to 55 percent, with African-American women also experiencing a significant increase in osteoporosis screening from 16 percent to 38 percent. The report also suggests that income is a factor in screening for osteoporosis, with only 46 percent of poor women having a screening test, compared to 80 percent of high income women in 2006.

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.