Consumer-directed health care plans can work, say employers in a recent survey, if the right tactics are used to help workers manage their health and benefits better.

Towers Perrin surveyed more than 120 major U.S. companies and found that many believe that CDHPs can help slow the growth of health care costs if they provide workers with information-gathering tools. "With the savings from managed care and vendor management initiatives behind us, employers are searching for workable solutions to the health care costs dilemma," says Jim Foreman, managing director of health and welfare at Towers Perrin.

However, the study also shows that employees can be downright dubious about CDHPs and any other proposal that seeks to shift more of the costs to them.

"Our survey suggests that many employees just aren't buying it, in part because they've been largely shielded from the true cost of health care during the managed care era and view rising costs as the company's problem. What comes through loud and clear in our survey is that, for employees, health care is all about me."

Which might explain why the makers of a computer game hope that tapping into that self-interest will be a way to educate workers.

The game, called Choosing Healthplans All Together (CHAT) asks a small group of participants to create a hypothetical group health plan. Created by physician ethicists at the National Institutes of Health and the University of Michigan Medical School, CHAT takes about two hours to play.

CHAT, described as a cross between Monopoly and Game of Life, offers possible health care options — "over a dozen types of services each with varying levels of coverage — that must be chosen within the limited budget of a typical health insurance premium. Groups of players decide what to include and what to eliminate from their plans," according to the University of Michigan.

Then real life intrudes in the form of Health Events Cards that players must draw in each round. These show the players how the health plan they created would perform in different circumstances.

The game has lessons for everyone, says Susan Dorr Goold, MD, of the University of Michigan, who is one of the co-inventors of the game. "CHAT helps ordinary people better understand health insurance, and helps health insurance policy makers better understand the health care priorities of ordinary people."

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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.