The renewed hope that shared decision making might finally fulfill its promise and lower costs (see our April cover story just hit some static. Patients who participate in their medical decisions spend more time in the hospital (0.26 of a day) and raise the cost of their stay by an average of $865, according to a study in JAMA Internal Medicine.

Researchers at the University of Chicago surveyed about 21,750 patients at the university’s medical center between July 1, 2003 and August 31, 2011. Ninety-six percent of the patients wanted more information about their treatment, while about 29 percent expressed a strong preference for shared decision making.

The authors say, “This contrasts with the expectation that patient participation in care decisions might decrease costs and suggests that it is important to evaluate efforts to increase patient engagement in decision making with respect to their effects on outcomes and costs.”

The study, “Association of Patient Preferences for Participation in Decision Making With Length of Stay and Costs Among Hospitalized Patients,” extrapolates the costs.

The authors say that “when multiplied by the approximately 35 million annual hospitalizations in the United States, the 28.9 percent of patients who somewhat or definitely disagreed with delegating decisions to their physician would represent about 10 million hospitalizations, for which an additional 0.26 day and $865 per hospitalization would total 2.6 million hospital days and about $8.7 billion in costs.”

Another red flag: The authors say that older patients, people with government sponsored insurance, and African Americans are less inclined to participate in care decisions.

“This could cause efforts to make physicians more responsive to medical decision preferences to increase health disparities by having little effect on utilization for these less empowered groups while increasing utilization among more empowered groups, who are already more likely to receive medical care.”

One of the study’s authors, David Meltzer, MD, says, “Patients who want to be more involved do not have lower costs. Patients, as consumers, may value elements of care that the heath care system might not.”

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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.

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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.
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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.