Despite a lack of evidence to show a return on investment, health and wellness programs in the workplace are now common, according to the Center for Studying Health System Change. For more details about how employers are encouraging employees to sign up or continue with their wellness program, see our Outlook column on page 56.

The driving force for these initiatives has come from large employers looking for long-term strategies to address rising costs and to give employees more responsibility for health care decisions and costs, according to “Health and Wellness Initiatives: The Shift From Managing Illness to Promoting Health.”

“We heard from employers and health plans that health and wellness activities are the right thing to do,” says HSC senior fellow Debra A. Draper, PhD, coauthor of the study.

The investment payoff for these programs has been difficult to demonstrate. Several health plan respondents said in the report that “it takes at least three to five years to have sufficient information to determine return on investment. Because many of the health and wellness activities in existence today have only been introduced recently and not yet evaluated, there is little credible evidence regarding return on investment.”

Health plans are also packaging, branding, and marketing health and wellness initiatives as a way to differentiate themselves in the crowded market.

Since health and wellness activities are voluntary, engaging enrollees is a challenge. Some type of incentive is needed to get employees to begin and to continue participating in the programs. Incentives include small cash payments to complete a health risk assessment, gift cards, discounts on gym memberships, and payment to participate in weight management programs.

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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.