In time, this may prove to be an interesting lesson in marketing. One year ago, Aetna U.S. Healthcare unveiled a bare-bones, low-cost health insurance product it said was a step toward reducing the number of uninsured Americans. Now, the company acknowledges that its experiment has failed to generate much enthusiasm.

Aetna won't say exactly how many people have signed up for its Affordable HealthChoices plans, but admits sales are slow. Aetna blames it on regulators' snail-like pace in approving the product, which is available in only 33 states.

Others in the industry, though, point to the very nature of the program as its weak spot. The three products pay $50 for a physician visit and $500 to $750 a day for the first three days of hospitalization. At the time it was unveiled, some consumer groups warned that enrollees who experienced serious illness or injury would be stuck with huge bills.

Then there are the skeptics, who say Aetna has never really pushed the program hard, using it only to score brownie points in Washington as debate about the uninsured intensified. The U.S. Chamber of Commerce and the National Federation of Independent Business, on the other hand, have applauded Aetna for its private-sector attempt to thin the ranks of the uninsured.

Depending on the state, individual premiums range from $46 to $91 a month — far less than other coverage on the individual market. Even so, some observers say it might cost just enough to dissuade small employers and the near-poor who don't qualify for Medicaid from joining.

Some worried that larger employers would abandon richer benefit structures for the stripped-down model, but that seems not to have happened. The Aetna plan's seaworthiness may be better gauged in weaker economic times.

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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.