Even if employees were motivated to get more involved in health care coverage decisions, and even if they had the know-how to weigh all the variables before making those decisions — two big ifs — they would not have access to the sort of informa-tion that they'd need to pull this off, says a report by the Employment Policy Foundation, an organization that studies workplace trends.

"A lack of transparency in health care prices and the absence of reliable data on quality of care for each health care provider make it difficult for consumers to make adequate health care choices," the EPF says in its report "The American Workplace 2005."

That's a sobering assessment in an era where the consumer is king, or a pawn, depending on whether you view the push for consumer-directed health care as an empowerment tool or as a ruse to shift more of the financial burden onto patients.

The EPF findings are echoed in an article in the Sept. 8 edition of the Wall Street Journal that finds that consumers who shop around in, for instance, New York City, can wind up paying anywhere from $400 to more than $1,500 for an MRI. For mammograms, the price ranges from $50 to $300. True, the Journal was able to get a price quote without much trouble, usually in a phone call lasting no more than five minutes.

"But the bad news is that we didn't always get accurate information," the paper reports. "When we called New York University Medical Center, a person in the billing department told us the rate for an MRI was $2,000. But when we called the medical center again, this time as a reporter to get a comment about the price, it gave us a different figure: $1,100."

These sorts of findings point to possible problems with health savings accounts, one of the linchpins of the Bush administration's effort to change the system. Under HSAs, enrollees may set aside money tax-free, either individually or through joint contributions with employers.

Any unused portion may be rolled over from year-to-year, and the accounts are entirely portable as well. Members may take their HSAs from job to job, just as they would a 401(k).

EPF President Janemarie Mulvey warns that if the purpose of HSAs is to make consumers more savvy about health care purchases, then a better foundation may be needed.

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.