It's a common lament that all but the biggest companies buy health benefits primarily on the basis of price, not quality. New findings by the Washington Business Group on Health back up that assertion — eveneven though employers admit that they know better.

Only a third of 360 employers who responded to a WBGH survey routinely get quality-of-care data on plans with which they contract. But what purchasers do and what they know they should do are two different things: 88 percent rated quality as the most important factor in choosing health plans. This professed ideal doesn't square with plans' opinions of their clients, as only 46 percent of HMO executives view quality as employers' top concern. Nearly 100 health plans were included in the survey, as were more than 350 providers.

Among providers, just 22 percent send outcomes data to payers. It can be argued that this part of the feedback loop is the missing link that prevents a holistic approach to quality improvement and is what fuels calls for accrediting bodies to sharpen quality evaluation at the provider level.

The National Committee for Quality Assurance is moving health care closer to that goal. NCQA has received a Commonwealth Fund grant to examine consumer information needs, the aim being to use the findings to develop consumer-friendly measures of physician and physician-group quality. NCQA has said it would like to measure quality at the physician level — the level at which most people feel a connection to the health care system.

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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.