We have for many years reported on health disparities based on race or ethnicity, with minorities often showing higher rates for many diseases and conditions, so this study comes almost as a shock. The age-adjusted esophageal cancer death rate for black men and black women younger than 65 decreased by 38% and 47%, respectively, from 1990 to 2010, according to the Centers for Disease Control and Prevention (http://tinyurl.com/esophageal-cancer).

The death rate increased for white men in that age group by 26% from 1990 to 2002 before stabilizing the rest of the decade. For white women the rate stayed about the same. In 2010, esophageal cancer death rates were nearly 40 per 100,000 population for white and black men under 65 and nearly 10 per 100,000 population for white and black women in the same age group.

A study by the National Cancer Institute notes that of the two types of esophageal cancer — adenocarcinoma and squamous cell carcinoma — the former is the most common because of its rising incidence, “particularly in white men.” The NCI says that about $1.3 billion is spent in the United States each year to treat esophageal cancer.

Esophageal cancer death rates by race and sex

Esophageal cancer death rates by race and sex

Rates are per 100,000 population. Rates have been revised by using populations enumerated as of April 1, for 2000 and 2010, and intercensal estimates as of July 1 for all other years. Therefore, the rates might differ from those published previously.

Deaths from esophageal cancer include those coded as C15 in the International Classification of Diseases, 10th Revision (ICD-10) and as 150 in the International Classification of Diseases, Ninth Revision (ICD-9).

*In 1999, ICD-10 replaced the ICD-9 for mortality tracking (e.g., on death certificates — not for payment purposes). Little change was observed in the classification of esophageal cancer deaths from ICD-9 to ICD-10.

Source: Centers for Disease Control and Prevention, National Vital Statistics System

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.