Health insurers that struggle to present information to consumers so that those folks can make the best choices can't afford to forget about the human factor. Fear and insecurity play a huge role in how people make decisions about health coverage, according to a study by Towers Perrin.

A survey of more than 1,400 employees of large and midsize businesses in the United States shows that 52 percent have negative feelings about their coverage and most of those people feel intensely negative.

"People are afraid, first of all, that their insurance won't protect them against financial hardship in the event of unforeseen medical needs," says Dave Guilmette, the managing director of Towers Perrin. "They also have serious concerns about navigating the provider system — not finding the right doctor, not knowing which tests to take, what treatments are best or which programs would provide the best care."

Towers Perrin uses the term "fear factor" and suggests that companies can help calm workers — and so can insurers.

"Health plans are often in a better position than employers who sponsor health coverage to give consumers confidence in their care management and purchasing decisions," says Martha B. Terry, a principal of the company. "The study tells us that consumer engagement can be increased significantly when consumers are confident and secure in their decisions."

Patients generally turn to physicians for that sense of security, "but if we can move the role of health plans from administering the experience to guiding and supporting decision-making through education, targeted outreach, and increased literacy about care delivery and management, the data suggest consumer engagement and positive emotion will follow," Terry says.

There's a message for the number-crunchers among health plan executives, as well, says Charlie Watts, another principal and the practice leader for measurement and research at the consulting company.

"While cost is certainly a continuing driver of negative opinion about the health care experience, affordability is less important than the sense of security and protection," says Watts. "In other words, simply lowering costs . . . is not the answer. Likewise, issues related to administration, quality, and choice, often featured by employers and health plans, . . . are again far less important determinants than security and protection."

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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.