Six large employers have pooled resources to offer a low-cost, limited-benefit health plan for workers who would otherwise be uninsured. The companies are IBM, Sears, General Electric, Avon Products, Federal-Mogul, and EMC, a computer storage company. They've started a company called HR Policy Association that is being administered by UnitedHealth Group.

"Because our health system is primarily employment-based, it makes sense for large employers to take collective action to try to come up with innovative, collaborative solutions to this pressing problem," J. Randall MacDonald, a senior vice president for human resources at IBM, tells the New York Times.

Enrollees will be provided a medical card that allows a discount for prescription drugs as well as medical and dental checkups for $6.99 a month. They will also have access to a 24-hour phone bank staffed by nurses.

Interestingly, the addition of the nurse phone bank raised the price of the limited-benefits plan from $4.41 to $6.99, an increase that was welcomed by the enrollees. Focus groups of potential enrollees "expressed skepticism that any card that costs less than $5 would be worth having," according to the Times.

The newspaper also reports that UnitedHealth is "offering the discount card and four levels of limited coverage in all 50 states at monthly premiums ranging from $59 to $149. In 15 states, UnitedHealth will also offer high-deductible policies that cover major medical costs, under the same group rules with no add-on charges for people with preconditions."

The business rationale behind limited-benefits health plans is just as basic as the coverage: Something is better than nothing.

On the other hand, limited-benefit plans — also called mini-med plans — are a natural magnet for the scorn of consumer advocates, many of whom have lambasted these sort of plans for leaving workers vulnerable to the multitude of medical catastrophes that could threaten us all.

Proponents counter that rising insurance costs are pushing most traditional plans even further beyond the reach of Americans on the bottom rung of the economic ladder.

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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.