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Managed Care

Elizabeth A Brooks, Marc Massanari
PURPOSE: Current asthma guidelines combine treatment, follow-up, and reevaluation to manage asthma control, reduce impairment, and decrease risk of morbidity in patients. Clinical use of biomarkers, such as fractional exhaled nitric oxide (FeNO), along with standard management can provide clinicians with improved ability to recognize airway inflammation, optimize drug therapy, and potentially increase asthma control. Our objective is to examine the impact of FeNO monitoring on the cost effectiveness of asthma management compared with management without FeNO...
July 2018: Managed Care
Renée Jg Arnold, Marc Massanari, Todd A Lee, Elizabeth Brooks
Asthma is a common chronic respiratory disease affecting nearly 8% of the U.S. POPULATION: It results in substantially higher direct and indirect costs as well as an increased mortality risk and poorer quality of life, particularly among patients with difficult-to-control asthma. While several physiologic tests, including spirometry, are typically used to diagnose and characterize asthma, they do not provide the sensitivity and specificity required to accurately reflect the underlying heterogeneous inflammatory pathways...
July 2018: Managed Care
Bob Hough
Now that Geisinger is confident in the payment process for providers, it will continue to innovate new ways to improve the member experience. The goal is to be not just one of the top companies for members and not just one of the top health care organizations, but one of top organizations among all the companies in the United States.
July 2018: Managed Care
Bruce Pyenson, Gabriela Dieguez, Katherine Simon, Andrew Bochner
Despite standardization, advocates for various industries and certain patient needs continue to propose changes in coverage rules. Much of the advocacy is occurring at the state level with a focus on pharmaceutical coverage, such as equalizing cost sharing between oral and infused oncology drugs or setting limits on cost sharing for prescriptions.
July 2018: Managed Care
François de Brantes
Price transparency, payment reform, and consumerism are needed to bring market forces to health care. Too many managed care organizations are comfortable with the status quo.
July 2018: Managed Care
Howard Wolinsky
The time may finally be here for standalone continuous glucose monitors. It's been a long road. Medicare and consumer health plans were slow to cover them, but now the FDA has approved four such devices. Experts expect that nearly 3 million Americans will be able to use the devices.
July 2018: Managed Care
Zachary Hafner
Zachary Hafner: "For the December 2017 issue of Managed Care, I wrote a piece titled, 'Better for Patients, or Better for Business-Do We Really Have To Choose'? I put forward several predictions related to key trends for 2018. Now that we have reached the midpoint of the year, it is a fitting time to check in and see how accurate those predictions have been."
July 2018: Managed Care
Richard Mark Kirkner
The pipeline for gene therapies is flush. lists 721 gene therapy trials. Last year, the FDA received 106 new drug applications for gene therapies, up 34% from 2016. There is no shortage of diseases for gene therapies to target. But the costs of these therapies will break the bank.
July 2018: Managed Care
Jan Greene
Genetic tests are all the rage, but insurers are well aware of the downside. Genomics is complicated, and test results are often couched in uncertainty and loaded with caveats. The tests available to consumers may not be clinical quality, so if something questionable pops up, the tests need to be redone anyway. A positive result could also lead to a cascade of additional, expensive, and potentially risky diagnostic tests.
July 2018: Managed Care
Thomas Reinke
Aimovig (erenumab-aooe), codeveloped by Amgen and Novartis, has been recently approved for the prevention of migraines. Its mechanism of action is different than other migraine medications. But perhaps more interestingly, it is the first drug recently developed specifically for migraine prevention.
July 2018: Managed Care
Michael D Dalzell
A report from the Hutchinson Institute for Cancer Outcomes Research is remarkable. Committing to transparency as a catalyst for improvement, 27 hospital systems and cancer centers across Washington State bare all in the first public report to integrate clinic level quality and cost data in oncology.
July 2018: Managed Care
Richard Mark Kirkner
After years of court challenges, agency-imposed fines, and drugmaker lobbying, those restrictions on off-label marketing are loosening up. The agency is working on revisions to rules that govern how drug companies and their sales representatives can communicate with doctors and payers about off-label use.
July 2018: Managed Care
Joseph A Ladapo, Matthew J Budoff, Pejman Azarmina, David Sharp, Alice Baker, Bruce Maniet, Lee Herman, Mark Monane
PURPOSE: The evaluation of obstructive coronary artery disease (CAD) is inefficient and costly. Previous studies of an age/sex/gene expression score (ASGES) in this diagnostic workup have shown a 96% negative predictive value, as well as an 85% decreased likelihood of cardiac referral among low-score outpatients at 45 days. The objective was to explore the one-year cost implications of ASGES use among symptomatic outpatients. DESIGN: A prospective PRESET Registry (NCT01677156) enrolled stable, nonacute adult patients presenting with symptoms suggestive of obstructive CAD at 21 U...
June 2018: Managed Care
Thomas Morrow
Trogarzo (ibalizumab-uiyk) is a CD4-directed post-attachment HIV-1 inhibitor, indicated for use with other antiretroviral inhibitors in adults with multidrug resistant HIV-1 infection who aren't responding to their antiretroviral regimen. It is considered an advance. But FDA approval was based on a study of only 40 people-and it had no control group.
June 2018: Managed Care
Jan Greene
Breaking up type 2 diabetes into subtypes has been something that clinicians and researchers have discussed and debated for years. Swedish researchers have proposed a new taxonomy to do just that. If it takes, the trick will be to come up with treatment plans that fit individual patients based on these more precise diagnostic categories.
June 2018: Managed Care
Sarah Kwon
The stakes are particularly high when interpretations differ on evidence for treating diabetes, a condition affecting 30 million Americans and costing $245 billion annually. New guidelines from the American College of Physicians recommend less stringent blood sugar targets for most people with diabetes. Other professional groups think that's a terrible idea.
June 2018: Managed Care
Craig Kasten
Health care is increasingly becoming like other retail encounters-a transaction between buyers and sellers. Patients, providers, payers-everybody needs to adjust. With the right technology and the will to change, the process of paying for health care can become as simple-and as painless-as getting a haircut.
June 2018: Managed Care
Robert Calandra
The PBM industry is under fire these days for what critics call its lack of transparency and its knotty contract language, secretive pricing schemes, and an inscrutable assortment of rebates, discounts, side deals, and administrative fees. Some see partnerships with insurers and retailers as a possible solution. Opponents see a risk of even higher drug prices.
June 2018: Managed Care
Ed Silverman
A state senator who describes insulin prices as "outrageous" introduced a transparency bill that requires drugmakers to report pricing, costs, and rebates. Other states might make similar moves, and the pharmaceutical industry is suddenly on edge, with PhRMA and BIO fighting the law in court.
June 2018: Managed Care
Timothy Kelley
Even the most effective drug is useless if its cost prevents people from using it. Today's high drug prices are pushing more patients into nonadherence. This can impair or shorten life, and that's toxic for a system that has trouble controlling costs as it is.
June 2018: Managed Care
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