Those who have argued that consumer-directed health care will stumble because of employees' disinclination and downright inability to manage their benefits will find rueful affirmation in some recent survey data.

First, there's the 2006 Employer Health Benefits Survey by the Kaiser Family Foundation and the Health Research and Educational Trust.

Based on a poll of 3,159 companies, it finds that only about 4 percent of covered workers are enrolled in such plans, "a rate statistically no different from last year."

Then, there's the survey of more than 18,000 employees announced with: "Hewitt Study Finds Employees Struggling To Effectively Manage Their Health Care."

It states that only 30 percent of employees in high-deductible health plans with health savings accounts "understood and were satisfied with their selection, and more than half said they wouldn't re-enroll next year."

The press release was subtle: "As Health Care Becomes More Complex, Employees Look to Companies for Guidance."

Just ask Nick Bond about that. Bond runs a small transmission repair business in Fort Wayne, Ind. When he introduced a CDHP, his 34 employees were so confused that they inundated him with questions, the Wall Street Journal reports.

"At one point, he and his office manager had to hole themselves up in their offices for about two weeks developing a spreadsheet with price information on 32 drugs."

Some managers "have to turn themselves into instant experts both on health care and on the law." All the while asking if it's worth it, we suspect.

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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.