The number of children diagnosed with mental disorders is increasing, bringing with it a $247 billion annual bill, according to a report by the Centers for Disease Control and Prevention.


“A total of 13%–20% of children living in the United States experience a mental disorder in a given year, and surveillance during 1994–2011 has shown the prevalence of these conditions to be increasing,” says the report “Mental Health Surveillance Among Children — United States, 2005–2011” (http://tinyurl.com/CDC-mental-report).


Attention-deficit disorder was the most prevalent parent-reported diagnosis among children aged 3–17. Behavior or conduct problems were second (3.5%), followed by anxiety (3%), depression (2.1%), and autism spectrum disorders (1.1%).


Mental disorders are among the most costly problems to deal with in children, and the authors of the study — published as a supplement to the May 17 edition of the CDC’s Morbidity and Mortality Weekly Report — cite other studies to make the case.


“[One] included insurance claims from approximately 20% of the privately insured U.S. population aged <65 years with private insurance and weighted the data to reflect a national estimate. This study reported a 24% increase in inpatient mental health and substance abuse admissions among children during 2007–2010, as well as increases in use and cost of these services and psychotropic medications for teenagers specifically over the same period” (http://tinyurl.com/children-report).


The study addressed the vexing problem of just how mental disorders among children can or should be measured.


“Substantial but not insurmountable challenges to surveillance of mental disorders in children exist.... Criteria for mental disorders are subjective, are based on a symptom count instead of a biologic measure, might require assessment by different persons or in different settings, and might change over the course of development.”

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.