Without a change in course, middle- as well as low-income families might eventually be priced out of the health insurance market.

If premiums for employer-sponsored insurance grow in each state at the projected national rate, then the average premium (constant dollars) for family coverage would rise from $12,298 (2008 average) to $23,842 by 2020 — a 94 percent increase.

Further, between 1999 and 2008, employer-sponsored family health insurance premiums rose by 119 percent nationally, while median family income rose by 29 percent, according to the U.S. Census Bureau, Current Population Survey.

If national health reform were able to slow premium growth by just 1 percentage point in all states, by 2020 employers and families together would save $2,571 per premium for family coverage, compared with the projection. By 2015, with a 1.5 percentage point slowdown, families could save $1,682. The savings would more than double — to $3,759 — for 2020.

In 2003, North Dakota had the lowest premiums, while the District of Columbia had the highest. But Idaho had the lowest premiums in 2008, and it should continue to hold that place in 2015 and 2020. Massachusetts will have the highest.

Projections for family premiums in 2020 range from $21,009 in Idaho to $26,730 in Massachusetts.

These findings are presented in the Commonwealth Fund’s August report, “Paying the price: How health insurance premiums are eating up middle-class incomes.”

Premiums for family coverage, 2003, 2008, 2015, 2020

Projected annual savings in family premiums, 2015 and 2020

*Premium estimates for 2015 and 2020 based on CMS Office of the Actuary, National Health Statistics Group, national health expenditures per capita annual growth rate.

Source for both charts: The Commonwealth Fund. Data Brief: Paying the price: How health insurance premiums are eating up middle-class incomes. August 2009

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.