The opening murmurs in negotiations between health plans and large employers have been heard. Insurers are expected to seek an average 13.7 percent hike in premiums in 2005, according to a survey of 160 large employers by Hewitt Associates.

Again, that's an average, not a consensus. Different insurers will ask for different increases.

For instance, the largest increase, 21.1 percent, is being sought by Anthem, according to Hewitt. UnitedHealth Group, on the other hand, is seeking a 10.2-percent increase. Also mentioned: Aetna, at 21.1 percent, Cigna at 13.2 percent, and Health Net at 18.9 percent. Not-for-profit Blue Cross and Blue Shield plans are expected to seek a 12.2-percent increase, on average.

The predicted rate of increase at the same time last year was 17.7 percent, although the actual increase ended up averaging 12.7 percent after plan negotiations and other changes.

Some experts believe that the lower starting point this year might mean that premium increases could drop into the single digits after negotiations — the first time that's happened in five years. Predictions range from 6 percent to 9.5 percent.

It would be the second year in which premium increases were lower than the previous year. Ken Sperling, the director of the Hewitt survey, attributes the relatively small increase to health plans reaching comfortable profit margins.

As a result, insurers are willing to price closer to underlying medical costs, which Sperling says are increasing 9 percent to 10 percent this year, down from 12 percent last year.

The growing trend of businesses shifting costs to workers is also reflected in the predictions.

Workers are expected to become more cognizant of just what their choices cost the system.

"We expect companies to continue pursuing strategies that allow consumers to better manage their health and make smart choices about the health care services they consume," says Sperling.

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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.