Acute kidney injuries (AKIs) increased greatly from 2000 to 2009 in terms of both incidence and mortality rates, according to a study in the Journal of the American Society of Nephrology.

The authors describe acute kidney injuries as those requiring dialysis.

“The total number of deaths associated with dialysis-requiring AKI rose from 18,000 in 2000 to nearly 39,000 in 2009,” says the study “Temporal Changes in Incidence of Dialysis-Requiring AKI.” The authors continue that “the incidence of dialysis-requiring AKI increased rapidly in all patient subgroups in the past decade in the United States, and the number of deaths associated with dialysis-requiring AKI more than doubled.”

AKIs requiring dialysis rose about 10 percent annually. The number of hospitalizations resulting from the condition increased from 63,000 to 164,000. “In subgroup analyses, we found that dialysis-requiring AKI was more common in the elderly (versus younger age groups), men (versus women), and non-Hispanic blacks (versus non-Hispanic whites),” says the study. “All age, sex, and racial–ethnic subgroups showed a similar pattern of increase in disease incidence over the study period.”

When experts cite the epidemic of kidney disease, they are usually referring to chronic kidney disease (CKD) and/or endstage renal disease (ESRD), and “policy discussions related to kidney disease have mostly addressed ESRD and CKD,” the authors note.

“Because the number of non-dialysis-requiring AKI cases is approximately 10 [times as high as] the number of dialysis-requiring AKI cases and because even small acute changes in serum creatinine are associated with increased morbidity and mortality, our data likely represent only the tip of the iceberg in terms of the public health burden of AKI.”

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.