The economic impact of Sept. 11 and the ensuing anthrax scare is still being calibrated, but it appears that health insurance premiums will increase even more than already had been predicted. USA Today reports that the terrorist attacks have led to increased physician and emergency room visits, as well as more prescriptions for antianxiety medication.

Many analysts before Sept. 11 had predicted that health care premiums would rise 13 percent or more next year.

Ed Kaplan, of the Segal Co., estimates that the terrorist incidents could nudge the rates up another 1 to 3 percent.

Not all analysts agree, saying that it is difficult to make accurate predictions at this point.

Blaine Bos, of William M. Mercer, told the newspaper that the health care services that have increased the most since Sept. 11 are "lower-cost items," such as physician-office visits and generic antianxiety drugs.

Cost pressures may come from other quarters as well. As Congress debates renewal of the Mental Health Parity Act, it can be argued that Sept. 11 added urgency to expanding access to behavioral services.

A recent study by the Pew Charitable Trusts found that 71 percent of Americans have felt depressed by the attacks. Nearly half had trouble concentrating; a third had trouble sleeping.

Mental health professionals have warned that the scope and magnitude of the tragedy can be expected to generate unprecedented mental health consequences, and that the mental health system does not have the necessary resources in place to meet the onslaught of psychiatric disorders anticipated.

Poor health related to anxiety has shown up in the workplace as well. An AdvancePCS survey found that health troubles caused a loss of 4.5 productive hours per worker the week after the attack — more than double the 2.1 hours lost the week earlier.

Not helping matters at all is the growing concern that information the government disseminates concerning the domestic threat is spotty at best.

One example of that is the fact that for about two weeks before information on other antianthrax medications began to be circulated, the Food and Drug Administration didn't combat the perception that ciprofloxacin, and only that product, can combat anthrax.

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.