Alzheimer’s disease (AD) may be the third largest cause of death, behind heart disease and cancer.

More than 500,000 die of AD each year, according to the study “Contribution of Alzheimer Disease to Mortality in the United States.” That’s much higher than the 84,000 estimate by the Centers for Disease Control and Prevention (CDC), which lists dementia as the sixth-largest cause.

“Overall, the data indicate that the proportion of older persons who die of AD is much higher than the number indicated by death certificates, which is less than 5% of all deaths in the elderly,” says the study, published March 12 in the journal Neurology.

Researchers, following about 2,600 people ages 65 and over for an average of eight years, believe that the underreporting starts with how those death certificates are filled out. Dementia progresses over years, causing complications such as malnutrition that can lead to pneumonia.

“These more proximate causes are listed on the death certificate as immediate cause of death, while dementia is often omitted as an underlying cause,” the study states. “Attempting to identify a single cause of death may not capture the reality of the process of dying for most elderly people because multiple factors may contribute to death in the elderly, some proximate and some distal.”

It may be time for the medical profession to embrace the concept of mixed mortality.

“This more nuanced view of ‘cause of death’ is needed for an accurate understanding of the contribution of chronic diseases such as AD to death in rapidly aging populations.”

The data do not include deaths attributed to mild cognitive problems caused by AD “so we likely underestimated the true number of deaths attributable to AD; prior work has found that mild cognitive impairment is associated with mortality.”

However, “even if our estimates of hazard of death were off by a factor of two, this figure would be approximately 200,000, which is still substantially higher than the figure from the CDC.”

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.