John A. Marcille

John A. Marcille

It is perhaps inevitable that as the newly re-elected President Bush struggles to usher in his "ownership society," health savings accounts should garner increasing attention. As our cover story by Contributing Editor John Carroll makes clear, the interest in HSAs will continue to grow.

In fact, we could be talking about the Next Big Thing in health care insurance. Some plans are not sitting idle while history washes by. Aetna, in particular, has been quick to roll out HSAs. "It's more and more what people hear about," points out Chris Hakim, the company's small-business leader in the western region.

Elsewhere in this issue, people have been hearing about disease management and direct-to-consumer advertising for a very long time, which doesn't mean that they can't hear something new about them.

Our story on DM looks at how Kaiser Permanente flexes corporate muscles unique to that health plan in cutting costs dramatically for asthma patients.

Our story on DTC advertising wonders if it's really as effective as many claim (you may be surprised at some of the takes on this issue).

For something really new under the sun we turn to the old, or at least how to care for the old. Our story on geriatricians shows how Medicare Advantage plans might employ these specialists. Demographics more and more demand it.

We cover a changing industry in a changing world. That means, I guess, that we cover change, without which no publication could exist. These are exciting times in which to be living. But weren't they always? Now, on to the ownership society.

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.