Health savings account (HSA) insurance plans continue to thrive, with more than 11.4 million Americans covered, up 14 percent from last year alone. HSAs were launched in January 2004, authorized by the Medicare Prescription Drug Improvement and Modernization Act of 2003.

Since then, America’s Health Insurance Plans (AHIP) has conducted annual surveys to keep track of this insurance offering. The latest report, “January 2011 Census Shows 11.4 Million People Covered by Health Savings Account/High-Deductible Health Plans (HSA/HDHPs),” says that enrollment in HSA plans has nearly doubled over the last three years, going from 6.1 million enrollees in January 2008 to 11.4 million in January 2011.

As a percentage of total enrollment in private insurance, though, HSA/HDHP enrollment is relatively small — 6.6 percent.

AHIP reports that 83 health insurers and their subsidiaries offered HSA/HDHP products. Seventy-three of these companies reported HSA/HDHP enrollment in the individual market; 72 insurers reported having small-group market offerings, and 70 insurers had enrollment in the large-market group market.

The fastest growing segment of the HSA market was the large-group coverage plans, which rose 26 percent between January 2010 and January 2011. The individual market followed, growing 15 percent during the period. In the individual market, 2.4 million were enrolled in HSA plans.

States with the highest percentage of HDHP enrollees were: Minnesota (14.9 percent); Vermont (11.4 percent); Colorado (11.3 percent); Montana (10.8 percent); Ohio and Indiana 10.6 percent each. The states with the highest levels of HSA/HDHP enrollment were: California (1,073,319); Texas (844,832); Ohio (728,868); Illinois (690,509); and Florida (656,243).

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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.