The days of employers scrambling to provide a choice of health benefits packages to lure and keep employees may be ending. The New York Times reports that large companies across the country are sharply reducing the number of HMOs they offer.

It's an effort to survive in an environment that features rising health care costs and a weakening economy.

Companies now feel that contracting "with everyone in sight" is an idea that backfired, Arleane Baltrusitis, vice president for benefits at American Express, told the paper.

"Twenty years later," she added, "we realized that we had lost any leverage" with HMOs. American Express, which covers 60,000 employees, 6,000 retirees, and their dependents, jettisoned 164 health plans, keeping only 48. With relatively few employees in each local plan, American Express felt that it could not negotiate with HMOs on services and price.

American Express is by no means the only company that feels this way. Sears Roebuck dropped 120 HMOs and kept 65. Xerox removed 92 HMOs from its roster of 222, though employees who are current members of the dropped HMOs have the option of sticking with those plans.

In recent years, as a result of the managed care backlash, employers avoided highly restrictive forms of managed care and offered more choice to employees. This tendency to backtrack appears to be extremely widespread, says Jim Maxwell, health policy director at the JSI Research and Training Institute, who studied the problem for the National Health Care Purchasing Institute.

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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.