Medicare beneficiaries who live in an area with more primary care had better outcomes and are less likely to end up in the hospital with a preventable disease, say researchers from the Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth Medical School.

Previous studies had mixed results. The new research looked at how much primary care was actually delivered to patients and not just how many primary care physicians were in a certain area. Researchers linked age-adjusted death rates, hospitalizations, and Medicare spending to the number of primary care physicians across the United States, based on counts from the American Medical Association. They found that in areas that had the top 20 percent of number of primary care physicians, tiny improvements were seen in preventable diseases over those in the bottom fifth. That finding did not hold when the number of deaths was examined.

When the researchers focused on how many doctors in the AMA were actually practicing primary care, the differences became larger. Those areas in the top fifth had 5.19 deaths per 100 Medicare beneficiaries annually compared to 5.49 per 100 for the bottom fifth. For preventable hospitalizations attributed to asthma and diabetes, the rates were 73 per 1,000 beneficiaries and 79 per 1,000, respectively.

The researchers suggest that having more primary care physicians available has a generally positive health benefit for this population, but that this association may not simply be the result of having more physicians trained in primary care in an area. Instead, associations were much stronger when primary care was delivered in an ambulatory setting such as a physician’s office or clinic by a physician trained in primary care.

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.