The turbocharged rush to offer choice to consumers leaves a question in its wake: Choice of what? It turns out that consumers value having a choice in providers more than having a choice of health plans, according to a study by the Commonwealth

Fund, which warns that "policymakers should be cautious about embracing the individual market and health savings accounts as a way to improve satisfaction in the system."

Furthermore, the survey of 3,293 adults ages 19 to 64 found that "respondents expressed confidence in employers' role in selecting health plans — even when they were not enrolled in an employer-sponsored plan — and two of three adults preferred an employer-selected set of health plans to an employer-funded account to be used for purchasing health insurance in the individual market."

OK. Let's take a deep breath. What the Commonwealth Fund survey seems to suggest is that there is no groundswell of consumer demand for consumer-directed health care. It certainly seems to shine a skeptical light on the phrase "consumer-driven health care" that those who want to see this change often use. Consumers aren't driving this shift. They, for the most part, like things just as they are, according to the Commonwealth Fund survey. "...[T]he type of choice that people most desire — where to go for care — may not be met by policies that promote a shift from employer-based coverage to individual market insurance."

"This all suggests that satisfaction with care is more closely associated with the ability to choose providers than the ability to choose health plans," says the survey, titled "'Choice' in Health Care: What Do People Really Want?"

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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.