Helen Darling

Helen Darling

Helen Darling is president of the National Business Group on Health (until recently, the Washington Business Group on Health). The group's members are 185 of the nation's largest private and public sector employers representing about 40 million workers, retirees, and their families.

By 2009, there may at last be a general recognition about the lack of safe care and the poor level of quality in our country. Committed effort by employers and the government will be needed to tackle some disturbing trends.


As a nation, we are just beginning to directly experience the costs and health effects of an epidemic far larger and more dangerous than any that we have experienced in the 20th and 21st century, that is, the epidemic of obesity.

It is the scale of the problem that is so shocking. First, nearly 70 percent of U.S. residents are either overweight or obese. Nearly 30 percent are obese. On average their inpatient and outpatient health spending alone is 47 percent higher than for those people who are not obese.

They are almost certain to become diabetics, and they suffer from heart disease, knee and back problems, and depression. They are already costly to employers and the public sector. The problems will get much worse. Even more alarming is the heartbreaking growth in the number of obese children and adolescents.

Talent shortages

All workforces in the U.S. will be struggling with demographic challenges as the big baby boomer population ages into retirement and old age. The age cohorts immediately behind the boomers are much smaller and the group of people who are the new employees is still fairly small. The younger children of the boomers — known as the Millennials — will begin joining the workforce over the next five years and there are many of them but not so many as we will lose to retirement. So workforces are having to do more with less or rely on more capital-intensive technology to improve productivity.

Health care, though, is a particularly complicated field and relies more on people — nurses, physical therapists — who care about working with people and are in it more as a mission than as just any job. Yet, for the reasons discussed above, it will be less and less satisfying, making it harder to recruit people into health care.

Constant recruitment problems will add to the stress for all. Given the long, costly education and training process for physicians, and increased dissatisfaction with practice, by 2009, we are likely to face even more problems with physician supply, exacerbated by the growth in demand.


The evolution to a more consumer-driven or consumer-centric health care system will greatly complicate the delivery and financing of care for health plans and health providers. But it is a force that will be very powerful and have its full impact during the coming five to ten years.

For example, individuals with employer sponsored health coverage will have more choices but will also be spending more of their money to have coverage. They will, of necessity, have to pay more attention to their decisions and require more information. They will also be confused if coverage remains as complicated as it is today.

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.