Educating consumers might not be the way toward better outcomes after all, suggests a study of COPD self-management that’s raising some eyebrows. Patients in an intervention group were given four 90-minute seminars designed to help them spot

the symptoms of a COPD flare-up. They were also given an action plan on how best to respond. The problem: More people (27) died in the intervention group than the usual-care group (10). When monitors spotted this, the study was discontinued. “A Comprehensive Care Management Program to Prevent Chronic Obstructive Pulmonary Disease Hospitalizations” is in the May 15 issue of Annals of Internal Medicine.

Enrollment, which took place at Veterans Administration medical centers, began in January 2007 at six sites and eventually expanded to 20 sites. But enrollment had not reached even half of the target number when the study was ended in February 2009, although patients were followed for another six months.

Researchers and others immediately began to consider what might have gone wrong. They noted that two similar studies (by Bourbeau et al. and Rice et al.) showed that educating patients does help in the management of COPD.

“We cannot explain the unexpected increase in mortality … but we believe that the threats to internal validity, such as biased group assignment or biased outcome assessment, were not contributors,” the study states.

Jonathan Whiteson, MD, director of cardiopulmonary rehabilitation at NYU Langone Medical Center, told HealthDay News Service, “If you flip a coin, the odds are 50–50 that you’ll get heads, but, if you flip it just 20 times, you might only get heads a few times. If you keep flipping the coin, however, it will eventually even out. That could be what was going on here.”

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.