Health care is a bright spot on a somewhat grim snapshot of the well-being of America’s children, according to a study by the Annie E. Casey Foundation. The Kids Count report, which relies on a trove of data from state and federal agencies, says that children in 2010, the last year for which the data could be processed, faced growing economic distress. The report notes that while the unemployment rates have dropped from about 9.6 percent then to 8.2 percent now, rates of children living in poverty continued to rise since 2010, when 22 percent of children lived in poverty.

Meanwhile, “8 percent of children (5.9 million) lacked health insurance in 2010. That’s a 20 percent improvement from 2008 when 10 percent of children were uninsured.”

Children without insurance are less likely to have a primary care physician and, not surprisingly, less likely to receive care when they need it. “Although the provision of employer-sponsored health insurance is declining and most low-wage and part-time workers lack employer coverage, public health insurance has resulted in a modest increase in health coverage among children over the last decade.”

American Indians and Latino children are much more likely to be uninsured. The rates are 18 percent and 14 percent, respectively.

The study also looks at low-birthweight babies. “Nationally, low-birthweight babies represented 8.2 percent of all live births in 2009, unchanged from 2005. After gradually increasing … the [percentage] of low-birthweight babies has remained relatively stable for the past several years, slightly below the three-decade high reached in 2006 of 8.3 percent.” The top five states for children’s health are Vermont, Massachusetts, Maine, Washington, and New Jersey. The bottom are Nevada, Wyoming, Mississippi, New Mexico, and Montana.

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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.