A huge database of diabetes patients unveiled last month will be used to try to improve care for patients. The database, called the SUPREME-DM DataLink (derived from SUrveillance, PREvention, and ManagEment of Diabetes Mellitus) includes health information for nearly 1.1 million diabetics in 10 states. The information was contributed by Kaiser Permanente (six regions), Geisinger Health System, Group Health Cooperative, Health Partners, Henry Ford Health System, and the Marshfield Clinic.

It will provide “an opportunity to conduct comparative effectiveness research, epidemiologic surveillance including longitudinal analyses, and population-based care management studies of people with diabetes” and explore “associated risk factors, complications, and health outcomes in new ways,” according to a study published in the June 7 edition of Preventing Chronic Disease, a publication of the Centers for Disease Control and Prevention.

Gregory A. Nichols, PhD, is a senior investigator at the Kaiser Permanente Center for Health Research and the lead author of the SUPREME-DM Project.

He tells Managed Care that, “With such a large and diverse population, we will be able to analyze the relative benefits of different therapies in a very comprehensive way. Because our data are longitudinal, we will, for example, be able to determine which therapies not only provide the best glycemic control in the short term, but which most effectively reduce clinical outcomes such as heart attacks in the longer term. In addition, we will be able to identify events that might not be seen in smaller data sets.”

Ronald Harris, MD, an endocrinologist at Geisinger Health System and one of the study’s investigators, says that “Once an accurate registry is developed, population intervention strategies can be specifically targeted for early intervention, maintenance of risk factors at prefixed goals, or conducting interventions in populations with advanced disease,” says Harris.

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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.