AARP will expand its relationship with UnitedHealth Group and create a new relationship with Aetna to provide health insurance plans designed to meet the needs of its 38 million members and others who are over age 50. The new program is called AARP Health Aid. The agreement with UnitedHealth Group will include Medicare supplemental insurance, Medicare Part D plans, indemnity insurance products, and Medicare Advantage offerings. The Aetna agreement will include a PPO and a high-deductible insurance policy that could be used with a health savings account. When the products become available next year, AARP will be the largest provider of private insurance to Medicare recipients.... Savings from using the mail order option offered by PBMs help the member, but results in minimal cost reductions for the insurer, according to a recent study in the Journal of Managed Care Pharmacy. Researchers at the University of Texas–Austin reviewed claim records from two state-funded health plans. "The savings associated with mail order don't necessarily filter down to the sponsor. In this instance, the member realizes all the savings," says Michael Johnsrud, PhD, RPh, an associate director of the Center for Pharmacoeconomic Studies, University of Texas–Austin.... Nearly two thirds (63 percent) of 450 major employers in the United States that cover more than 8 million employees plan to make aggressive multiyear steps to help employees improve their health by increasing education efforts, implementing condition management programs, and using data analysis and other cutting-edge programs to improve health and productivity while holding participants accountable for their behaviors, according to a recent Hewitt Associates study. Less than 40 percent plan to maintain their current focus on health care benefits — primarily concentrating on annual cost mitigation.

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.