About 14% of children in the United States were diagnosed with asthma in 2011, according to the National Center for Health Statistics. That continues a trend of growing childhood asthma rates, though there is a caveat. “Between 1980 and 1995, childhood asthma more than doubled, to 8%. Methods for measurement of childhood asthma changed in 1997, so earlier data cannot be compared to data from 1997–2011.”

The statistics were published in the report “America’s Children: Key National Indicators of Well-Being, 2013” (http://www.childstats.gov/americaschildren/index.asp). The main thrust of the report is that nearly a quarter of children in the United States live in poverty, affecting their safety, education, and health. Exacerbating the situation is the fact that many children with asthma lack health insurance.

The report also says that about 10% of children in 2011 had asthma and that 5% of all children had one or more asthma attacks in the previous year.

Percentage of children up to age 17 with asthma, 1997–2011

Percentage of children up to age 17 with asthma, 1997-2011

NOTE: From 1997 to 2011, children are identified as ever diagnosed with asthma by asking parents “Has a doctor or other health professional EVER told you that your child has asthma?” If the parent answered YES to this question, they were then asked (1) “Does your child still have asthma?” and (2) “During the past 12 months, has your child had an episode of asthma or an asthma attack?” The question “Does your child still have asthma?” was introduced in 2001 and identifies children who currently have asthma.

Source: National Center for Health Statistics, National Health Interview Survey.

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.