UnitedHealthcare is taking some heat for dropping between 10% and 15% of doctors from its Medicare Advantage network nationwide. That means that some enrollees will not be able to continue seeing the physician of their choice. The insurer says the move will save money and improve quality in the long run. Tough sell so far. . . . The publicity surrounding the increase in the number of children being prescribed antidepressants, antipsychotics, and stimulants in the last decade might have paid off, according to a study in the journal Pediatrics. Use soared in the early part of the decade but leveled off between 2006 and 2009. . . . Although the numbers aren’t high, the United States saw a three-fold increase in measles last year — only 175 cases, but the disease is considered officially eliminated from the Western Hemisphere. That means it does not circulate within the general population but rather is entering the country with travelers, according to the Centers for Disease Control and Prevention.... Exercise reduces the risk of breast cancer and a study in the journal PLoS One says that it even helps once breast cancer is diagnosed. Women who exercise are 40% less likely to die from the disease than those who do not meet exercise guidelines. Those guidelines are not especially strenuous: seven miles of brisk walking or five miles of running a week.... The U.S. Preventive Services Task Force (USPSTF) is at it again. The task force often gets headlines when it rules that some test (such as mammography) might be overutilized. Now the USPSTF says that screening to identify early-stage dementia might not be worth it. The findings are in a study in the Annals of Internal Medicine (http://tinyurl.com/task-ruling) that the task force sponsored.

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.