The number of people who lost health insurance coverage because of layoffs could not be offset by an increase in the number of those using COBRA. This led to a relatively small increase in premiums for 2010.

Apparently, however, that’s going to change in the next several years, say authors of a study titled “Health Spending Projections Through 2019: The Recession’s Impact Continues,” published in the March issue of Health Affairs.

Expect to see a deceleration in private health insurance premiums in 2010 by 2.5 percent. That follows premium growth rates of 3.1 percent in 2008 and 3.3 percent in 2009.

That’s going to change by 2015, according to the study authors. Premium growth is projected to reach 7.1 percent — a reflection of an improving economy and increasing private health insurance enrollment beginning in 2012.

“Overall health spending grew faster in 2009 versus 2008, although we’re still at a relatively low level of health spending when historical accounts and projections are considered,” says Christopher J. Truffer, an actuary in the Office of the Actuary, Centers for Medicare & Medicaid Services, and lead author.

“After 2010, we’re projecting that private health spending will accelerate — a response to faster income growth and increases in private health insurance enrollment during the recovery. Once that surge passes, we’ll see a slowdown in private health insurance growth,” says Truffer.

Source: Truffer CJ, Keehan S, Smith S, et al. Health spending projections through 2019: The recession’s impact continues. Health Aff. 2010:29(3):1–8.

Private health insurance

Out-of-pocket payments

Other private funds

Estimated sources, all private funds (In billions)

Projected average annual percentage growth (%)

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.