More than a year after the passage of the Accountable Care Act (ACA), employers have seen an average increase in enrollment of their employees in health plans of around 2 percent, probably because the act extended eligibility for coverage of employees’ children up to age 26. That number is going to grow by another 2 percent on average by 2014, as employers will be required to automatically enroll newly hired and newly eligible full-time employees in a health plan, says a new survey from Mercer, the large human resources consulting company.

Expect costs to rise as a result. The Mercer report says about 28 percent of employers that responded expect an increase of at least another 3 percent in their projected 2014 plan costs, with 15 percent expecting an additional 5 percent increase or more in costs. The new provisions include extending coverage to all employees working 30 or more hours per week and to new full-time employees who are auto-enrolled. The law requires plans to pay for at least 60 percent of covered services.

About 27 percent of employers expect the increases attributable to the ACA to be more modest — about 2 percent or less — and 15 percent say their plans are already in compliance and will see no cost increases. The remaining 29 percent could not estimate cost increases.

Despite the increases, however, employers remain committed to providing coverage to their employees. Mercer reports that just 2 percent say they are “very likely” to terminate coverage after the insurance exchanges are operational, with another 6 percent “likely” to do so.

“That employers remain committed to providing employees with health insurance more than a year after the passage of the health reform legislation would seem to be good news for managed care plans,” says Beth Umland, director of research for health and benefits at Mercer. “Consumer-directed health plans, which generally meet the minimum plan value standard but cost significantly less than the traditional PPO or HMO plan, are likely to see increased growth.”

Expected employer cost increases under ACA

Source: Mercer

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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.