The man viewed by many physicians as a poster boy for health plan greed — Aetna U.S. Healthcare CEO Richard Huber — was forced into early retirement as shareholder criticism of his leadership mounted.

Aetna's stock price was near its 52-week low Feb. 25 when Huber resigned under pressure. Aetna faces a number of issues that may have dragged down its stock price, including operational difficulties related to its myriad acquisitions, a widening physician revolt, and a growing list of legal challenges from members.

Meanwhile, in Massachusetts, the saga of a once-mighty not-for-profit HMO dragged on with no end in sight. With two of the state's own deadlines for a rescue plan for Harvard Pilgrim Health Care long forgotten — and with the people shaping that plan suddenly playing their cards very close to the vest — the fate of the Massachusetts HMO has been left to speculation. But hospital executives around Boston have hinted that conversion to for-profit status is a strong possibility.

Those executives told the Boston Globe that they worried that that such a conversion would leave them holding the bag, because no for-profit buyer would be likely to agree to absorb the $210 million that Harvard Pilgrim owes hospitals.

The state is under pressure to put an end to the crisis because Harvard Pilgrim is losing members; the longer the process drags out, the lower the HMO's membership and, thus, its value. Observers do not think liquidation of Harvard Pilgrim is likely, given its million-member size.

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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.