Asthma rates are dropping, but don’t celebrate just yet warns a researcher at the Centers for Disease Control and Prevention. The percentage of Americans with asthma fell from roughly 8.6% in recent years to 7.4% in 2013. In addition, patients having an asthma attack or episode fell to a 15-year low of 3.8%, down from 4.4% in 2012. Jeannine Schiller, MPH, a lead researcher at the CDC, says that the downturn may just be a statistical anomaly, and wants to see 2014 statistics before pronouncing that asthma is in decline. . . . Yet more doubt has been thrown on the benefits of vitamin supplements. Antioxidants actually reduce the benefits of exercise, according to a study in the Journal of Physiology (http://tinyurl.com/vit-study). The study looks at 54 men and women, who are already in pretty good shape. Most of them are runners or cyclists. One half got a placebo; the other got the vitamins. At the end of an intense 11-week training program, both groups showed improvements but the ones taking placebo had more energy and better health. . . . If perception is reality (placebo, anyone?), then the debate over the worthiness of wellness programs might be moot. Workers who believe that their employers care about their health will give those companies a competitive advantage, according to a survey (http://tinyurl.com/survey-well) of 2,700 employees by the National Business Group on Health, Aon Hewitt, and the Futures Co. Such workers are also happier and less stressed. . . . When it comes to prescribing antibiotics, hospital doctors are all over the place, according to the Centers for Disease Control and Prevention (http://tinyurl.com/prescribe-hos). Physicians in some hospitals prescribe nearly 3 times as many antibiotics than physicians holding similar positions in other hospitals, according to a study of 300 hospitals. Some of the patients had not even been fully tested to see if they need an antibiotic. . . . Patients with type 2 diabetes that includes severe hypo­glycemia have more incidence of cancer and higher mortality than those who do not have sever hypoglycemia, according to a study in the journal Diabetes Care. Among the predictors of severe hypoglycemia are older age, low body mass index, and high A1c levels. . . . Seventy-three percent of older patients would prefer getting care that’s coordinated, but only 27% describe the care they get that way, according to a survey by the John A. Hartford Foundation. Patients who get coordinated care like it: 83% say that their health improved.

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.