November 2006

Whether a person is likely to develop diabetes, cancer, schizophrenia, or stroke will be reasonably well predicted, and tests can also determine whether a patient will respond to a given therapy. That's the good part.
Maureen Glabman
Paying for medical group practice redesign can significantly enhance the quality of care for chronically ill patients, and perhaps lower long-term costs
Martin Sipkoff
There are plenty of ways that confidential data can escape your control, and the consequences can be major. Can you trust your employees?
Ed Silverman
Germany has been able to enroll more than a million people with type 2 diabetes in DM programs through legislation that created incentives for physicians and insurers
Heinz Nagel, MD
Thomas Baehring, PhD
Werner A. Scherbaum, MD, PhD
This CMO of a pharmacy benefits manager wrestles with some of insurance's most taxing issues. Price, of course. And here come biologics!
Patrick Mullen



Departments
Viewpoint
Arthur Lazarus, MD, MBA
Legislation & Regulation
Despite an array of economically and politically strong advocates, a bill to beef up health savings accounts has stirred significant opposition
John Carroll
Medication Management
Many insurers may not consider insomnia a serious health problem, but it costs employers a bundle in lowered productivity
Martin Sipkoff
Employer Update
Still, some are skeptical about punishing bad behavior. For one thing, it makes coverage more expensive for those who need it most.
Lola Butcher
Tomorrow's Medicine
The use of transgenic goats to produce a recombinant form of human antithrombin is much more efficient than using mammalian cell cultures
Thomas Morrow, MD

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.