The number of companies that offer a consumer-directed health plan (CDHP) to their employees is steadily, albeit slowly, increasing. Nearly half of large employers say they have offered a CDHP to their employees, and the number of employees

enrolled in the programs has nearly doubled over the last two years, according to results of a survey by Watson Wyatt and the National Business Group on Health. Findings from similar surveys by the Center for Studying Health System Change and the Commonwealth Fund seem to echo these findings.

National surveys suggest that while CDHPs — typically high-deductible health plans accompanied by either a health reimbursement arrangement (HRA) or health savings account (HSA) — are being offered by a growing number of employers, enrollment in these products constituted just 5 percent of total enrollment in employer-sponsored health plans in 2007, according to the center.

In the Watson Wyatt/National Business Group on Health survey, of the 453 large employers who participated, 47 percent currently offer a CDHP; that’s up from 39 percent in 2007 and 33 percent in 2006. By 2009, 54 percent of companies plan to offer a CDHP.

With more employers offering this type of health plan, the number of employees who enroll rises as well. According to the survey, CDHP enrollment is about 15 percent in companies that offer it, up from 10 percent in 2007 and 8 percent in 2006. Only 6 percent of companies report 100 percent enrollment in a CDHP, but that number is projected to rise to 9 percent in 2009.

But does enrolling in a CDHP really save money? Of those companies with at least half of their workforce enrolled in a CDHP, the two-year median medical and pharmacy cost increase was about 3.6 percent. That’s about half of the increase for companies with no CDHP offering.

Overall, companies with a CDHP experienced a two-year cost increase of 5.5 percent, versus 7 percent without a CDHP.

“As popularity of the consumer-driven approach grows, companies will be able to better manage costs and workers will take a more active interest in their own health care,” says Helen Darling, president of the National Business Group on Health. “Actively involving more workers in their health care and giving them the resources to make educated decisions can be a challenge, but it should be embraced. The end result can be a mutually beneficial system for both companies and their workers.”

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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.