Medical directors “define who they are based on how much they have achieved,” points out Thomas J. DeLong, PhD, of Harvard Business School, one of the experts quoted in our cover story about medical director burnout. How is achievement measured? Sometimes, medical directors are hopelessly caught up in the business of managed care, a long way from doing the sorts of things that drew them into medicine in the first place.

“It’s like getting in a rut with nowhere to go,” says Abbie Leibowitz, MD, a former chief medical director at Aetna. “That is a bigger contributor to burnout than the stress. It’s not that the job is typically so overwhelming; it’s a much different level of stress than practicing medicine.”

If new and interesting challenges are part of the cure, then help is on the way, and one need look no further than our current issue. Medical directors (as well as pharmacy directors and other clinician executives at health plans) will need to decide what to do about new anti-obesity drugs, and how to improve rates for taking the vaccine for the human papillomavirus, which causes several cervical cancers.

Meanwhile, though, take care of yourself. Even though there’s no official diagnosis for burnout, it’s real. “If the depression or anxiety is intense, that would be a sign that the burnout might have precipitated a psychiatric disorder or be the consequence of a disorder that was not previously recognized,” says Philip R. Muskin, MD, professor of clinical psychiatry at Columbia University and a distinguished life fellow of the American Psychiatric Association.

And “psychiatric disorders are .... not in the ether,” he adds. “They are not something wrong with your moral fiber. They should be respected in the way they are treated.”

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.