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Facing significant increases in health-benefit costs, employers appear less willing to bite the bullet than in the past — and are passing many of those increases on to workers. As the cost of coverage crept upward during the last three years, a tight labor market and recruiting pressures led many companies to shield employees from the higher expense. A new national survey finds that with premium increases expected to cross into double digits this year, employers are more inclined to use cost-sharing techniques.

Of the 3,300 employers who responded, the share of those who said that they would increase employee contribution levels this year nearly doubled over last year. One such area is prescription drug coverage, though the added cost to employees doesn't keep pace with increases in pharmacy benefit costs.

Premium increases trend up

The average health benefit cost rose from $4,097 per person in 1999 to $4,430 in 2000.

HMOs lose cost distinction

For the first time in seven years, HMO premiums rose more sharply than those for PPOs.

Workers take the hit

The share of employers who intend to pass cost increases to workers nearly doubled.

Prescription-copayment increases minimal

Copayments go up 12.5 percent, though pharmacy accounts for 17.5 percent of all coverage costs.

SOURCE: WINNING THE LOYALTY OF THE E-HEALTH CONSUMER, DELOITTE CONSULTING, CHICAGO, 2000

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.