January 2010

Telemedicine has different aspects, and one is the seemingly simple connection of a doc and a patient. When the stars are aligned, such an encounter can save money and time.
Maureen Glabman
Ten percent of newborns are admitted to a neonatal intensive care unit. NICU costs are high but controllable.
Michael Kornhauser, MD
Roy Schneiderman, MD
Just because a benefit package costs a lot doesn’t mean it pays for everything or improves outcomes. Many variables come into play.
Frank Diamond
Pennsylvania’s mining of infection info, and the use of insurers’ own statistics in Maine are seen as great examples of measuring quality
John Carroll
Rehabilitation at a skilled nursing facility lacks the intensity that most patients need, studies suggest
Richard L. Harvey, MD
It is customary to think of this payment method as a cost-control mechanism, and it is, but it can raise quality of care too
Douglas J. Moeller, MD
James Evans
CDHPs and catastrophic insurance plans can save consumers money, but do high deductibles add to overall costs down the line?
Martin Sipkoff



Departments
Legislation & Regulation
Charges by lawmakers that insurers don’t spend enough on medical services lead to provisions in health reform bills in the Senate and House
John Carroll
Medication Management
Although effective treatments are available, helping patients cope is a minefield of administrative and legal barriers
Martin Sipkoff
Tomorrow's Medicine
If the Food and Drug Administration approves the bronchial thermoplasty system, it will be the first device specifically approved to treat the condition
Thomas Morrow, MD
Plan Watch
A unique health plan-provider partnership focuses on giving practical knowledge to those to whom the CEOs report
Frank Diamond

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.