Developing a meaningful screening tool for ovarian cancer will be more difficult than one might have hoped just a few years ago. This relatively rare disease often progresses with few symptoms until it is too late for curative treatments.

Adding to the differential diagnosis is the commonly used biomarker CA125 — elevated levels can suggest ovarian cancer, but also other less malignant disorders.

Ovarian cancer once was believed to be a single disease, but research now suggests that there are at least two distinct subtypes, a slow-growing, indolent form that may take from months to years to move to a more advanced stage, and a more aggressive variety driven by gene mutations. This form can move through stages 1 and 2 very quickly.

Laura Havrilesky, MD, an associate professor of gynecologic oncology, and other researchers at Duke University developed a decision model to help predict how aggressive such a cancer might be.

The researchers used data from the SEER database, which is maintained by the National Institutes of Health.

First, they applied the model using ovarian cancer as a single disease and found that screening women over age 50 had the potential to lower cancer deaths by about 15 percent.

But when they incorporated the two-subtype idea, the model predicted deaths would fall by only 11 percent.

“Catching and successfully treating the slower-growing cancers isn’t going to do as much to reduce deaths from ovarian cancer as catching the more lethal tumors,” she says.

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.