Millions of women who have had hysterectomies have gotten Pap tests despite recommendations nearly a decade old that say such tests are not needed and might actually do more harm than good.

The overall news about Pap tests is actually encouraging, though. A report in the January 3 issue of Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control and Prevention, notes that guidelines for Pap tests are in fact being more closely followed, especially by women younger than 30.

Those guidelines have been laid down by three organizations: the American College of Obstetricians and Gynecologists, the American Cancer Society, and the U.S. Preventive Services Task Force.

“In late 2002 and 2003, when the three organizations updated their guidelines, they all recommended that most women having had total hysterectomies for benign reasons should no longer be screened regularly, and the USPSTF recommended that women [65 and older] with a history of normal screening results should no longer be routinely screened,” the report states.

The percentage of women 18 to 21 who said that they’ve never been screened increased from about 24 percent in 2000 to about 48 percent in 2010; Pap tests are not recommended for women under 21.

In addition, Pap testing within the last three months for women 30 and older declined from about 73 percent in 2000 to about 59 percent in 2010.An improvement, for sure, but not so much as the authors would like to see.

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.