The number of Americans age 45–64 suffering from at least two chronic conditions grew from 16 to 21 percent between 2000 and 2010, according to a study by the Centers for Disease Control & Prevention.

For people age 65+, the number with at least two chronic conditions increased from 37 to 45 percent.

It gets worse, with the study saying that the increases were seen for “both men and women, all racial and ethnic groups examined, and most income groups.” The study looks at nine chronic conditions: kidney disease, asthma, hypertension, heart disease, diabetes, cancer, stroke, chronic bronchitis, and emphysema.

The percentage of adults age 65+ with both hypertension and diabetes increased from 9 to 15 percent. Hypertension and heart disease increased from 18 to 21 percent, and the combination of hypertension and cancer increased from 8 to 11 percent.

Three conditions are the primary drivers of this trend. The study states that “the prevalence of hypertension increased from 35 percent to 41 percent, diabetes from 10 percent to 15 percent, and cancer from 9 percent to 11 percent, among those aged 45 and over.” Moreover, the percentage of people ages 45–64 with two or more of nine conditions who did not receive or who delayed needed medical care because of cost increased from 17 percent to 23 percent, and the percentage who did not receive needed prescription drugs because of cost increased from 14 to 22 percent.

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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.