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Managing Care and Cost in a Profit-driven System

Managing Care and Cost in a Profit-driven System
Healio Rheumatology, November 2017

Clinicians who treat patients with rheumatologic diseases are facing an ever-growing set of non-clinical challenges. The issue at hand is managed care, and the crux of the problem is that the U.S. health care system has grown increasingly cumbersome and complex, forcing clinicians to spend more time dealing with bureaucracy and less time working toward patient outcomes. Moreover, some experts believe it to be problematic that the profit-driven structure of the U.S. health care system has increased the number of non-clinical and non-medical players involved. For example, pharmacy benefit managers initially filled the role of translator in a complex pay structure system, taking some administrative work away from clinicians and helping them focus on patients. However, their role in the system has increased, often without being sufficiently or clearly defined.

Non-medical switching of therapies is another concern for physicians, with payers forcing physicians to make clinical decisions they might not have otherwise made. Drug costs are increasing. Biosimilar therapies, though effective, face an uphill battle in the approval process in the United States.

Editorial

Rheumatology, Managed Care and Burnout

Healio Rheumatology, November 2017
Leonard H. Calabrese, DO
I recently chaired a CME program in Chicago, where I asked a polling question about which “obstacle” was the greatest impediment for effective patient care…
Meeting News

Gottlieb sees ‘watershed opportunity’ to shape future of FDA’s regulatory process

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WASHINGTON — When diagnosed with Hodgkin lymphoma at…
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AMA adopts new strategy for genetic tests, therapeutics

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AMA recently voted to advance the development of a comprehensive strategy that allows more consistent coverage of genomic and genetic tests and precision medicine, a…
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CME ABIM MOC

Ace the Case: A 50-Year-Old White Female with a 9-Year History of Rheumatoid Arthritis

There is no commercial support for this activity.

This “Ace the Case” study will explore the diagnosis and management of a 50-year-old white female with a 9-year history…
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Video
Meeting News

VIDEO: ADA laws help keep children with rheumatologic disorders in the school setting

August 11, 2017
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Resource Centers
American College of Rheumatology Annual Meeting

American College of Rheumatology Annual Meeting

CME

Operative Management Options for Traumatic Anterior Shoulder Instability in Patients Younger Than 30 Years: September 2015

Anterior instability of the glenohumeral joint is a relatively common problem in the young population. Identification…
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