Patients with high cholesterol who regularly take their statins have significantly fewer hospitalizations from cardiovascular problems and can reduce their health care costs by as much as $944 over 18 months, says a study from the American Journal of Cardiology. Lead author Donald G. Pittman, PharmD, of the Medco Research Institute and colleagues reviewed claims from 381,422 patients ages 18–61. Adherence was measured using the medication possession ratio (MPR) — the ratio of total days of medication supplied to the total days within a specified period.

The researchers found that the adherent patient group had significantly lower odds of cardiovascular-related hospitalizations compared with the nonadherent group. Health care costs for patients who were least adherent were nine percentage points higher than the patients who followed their prescribed regimen. Those who took their statins regularly had higher drug costs that were offset by lower medical costs leading to lower total health care costs.

While more than two thirds of patients were found to be adherent to their statin therapy (MPR ≥80 percent), 17 percent were identified as moderately adherent (MPR 60 percent to 79 percent) and 15 percent were classified as poorly adherent (MPR <0 percent to 59 percent).

Adherence, statin cost, and subsequent health care costs (18 months)

Source: Pittman DG, Chen W, Bowlin SJ, Foody JM. Adherence to statins, subsequent health care costs, and cardiovascular hospitalizations. Am J Cardiol. 2011;107:1662–1666

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.