A significant number of office-based physician practices have yet to implement an electronic health record (EHR), according to Sage Healthcare Division, a developer of EHRs. But their implementation “continues to grow as an increasing number of physicians and staff gain a better understanding of the efficiency and cost-saving benefits,” according to a recent company survey. It notes that federal “meaningful use” incentives are still one of the strongest drivers for most physicians (64 percent) to implement EHR technology, but for 32 percent of those who are in the market for an EHR, insufficient capital is still a key challenge.… The Government Accounting Office surveyed officials in insurance departments in all the states and the District of Columbia about their practices for overseeing premium rates in 2010 and changes they have begun making to enhance their oversight. The GAO noted widespread variability in reviewing, approving, or disapproving rate filings submitted by insurance carriers. Respondents from 38 states reported that all rate filings were reviewed before the rates took effect, while others reported reviewing at least some rate filings after the rates took effect. The types of information they reported reviewing varied, too. For example, nearly all reviewed trends in medical costs and services, but fewer than half reported reviewing carrier capital levels compared to state minimum levels.... Transitions in care are vulnerable periods for patients during hospitalization and a new study suggests admission to the intensive care unit is associated with an especially high risk of medication discontinuation. A study in the August issue of the Journal of the American Medical Association found that patients admitted to the hospital were more likely to experience unintentional discontinuation of medications than a control group. This applied across all medication groups examined. Getting admitted to an ICU was associated with greater risk of medication discontinuation than when hospitalization was not through the ICU, the researchers found.

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.