Faced with continually rising health care costs, employers are looking to consumer-directed health plans (CDHPs) and wellness programs to keep them down. There was a 43 percent increase in the number of CDHPs offered this year, compared to 2007. These plans make up nearly 13 percent of all plan offerings by employers. The percentage of employees enrolled in CDHPs nearly doubled from 2006 through 2007.

The findings, presented in the 2008 United Benefit Artists Health Plan Survey, also show that PPOs continue dominating the market with nearly 54 percent of plans offering this type of coverage and with nearly two-thirds of employees enrolled. HMO enrollment continues to slip and now represents 21.3 percent of plans offered, with only 13.3 percent of employees enrolled.

“The continued growth of CDHPs is a key headline to come out of the survey,” says Bill Stafford, UBA’s vice president for member services. “Fee-for-service and exclusive provider organizations have virtually disappeared.”

Employers are also increasingly offering comprehensive wellness programs to their employees. In fact, nearly 1 in 10 (9.8 percent) employers offers wellness programs in 2008, compared to just 7.4 percent in 2007. Of the employers that offer wellness programs, 79 percent include health risk assessments; 35 percent include seminars or workshops; 39 percent include on-site coaching or coaching by telephone for high-risk employees; and 40 percent offer biometric screening or physical exams.

Half offer incentives for participating in wellness programs.

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.