At least 40% of office-based physicians have a basic electronic health record (EHR) system, but they are unable to do some of the functions necessary for meeting stage 1 of the federal meaningful use objectives, according to a report by the Robert Wood Johnson Foundation (http://www.rwjf.org/en/library/research/2013/07/health-information-technology-in-the-united-states-2013.html).

There are 15 core objectives in stage 1 that must be met in order for the government to underwrite up to $44,000 in new technology costs per physician (https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/MU_Stage1_ReqOverview.pdf).

The authors surveyed 172 hospitals and physician groups between August and November 2012.

About half of the physicians say that they find it very difficult, somewhat difficult, or basically impossible to “generate lists of patients by lab results or need for overdue care, track referrals, or [generate] reports on quality of care.”

However, physicians who did meet the standards “were more likely to report that panel management functionalities were easy to use compared to physicians who did not meet the objectives.”

The three stages for implementing meaningful use standards are:

  • 2011–2013: collect and share data
  • 2014–2015: implement advanced clinical processes
  • 2016 and after: improve patient outcomes

“In 2012, 40% of office-based physicians had adopted at least a basic EHR,” the survey says. “These physicians were most likely to be primary care physicians in a practice of 11 or more physicians owned by a hospital, academic medical center, health maintenance organization, or other health care organization in rural places.”

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.