Employers “plan to sharply increase the incentive amount for maintaining a healthy lifestyle or participating in a wellness program,” according to a survey by the National Business Group on Health.

Companies know full well that the Affordable Care Act changes the minimum amount an employer can deduct from premiums under HIPAA from 20 to 30 percent.

Kevin Volpp, MD, PhD, director of the Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute, pointed out to us in March (http://preview.tinyurl.com/employer-incentives) that Section 2705 of the Affordable Care Act says that, “beginning in 2014, an employer may use 30 percent of an employee’s premium for outcome-based wellness incentives (and 50 percent in some cases, if the government approves).”

“They can say you are going to pay $10,000 a year, but if your body mass index is less than X, you don’t smoke, you have a low LDL cholesterol and a well-controlled blood pressure, you are going to pay $7,000 a year,” says Volpp. “This will change the current model considerably if employers start doing this.”

When the HIPAA-allowed wellness incentive limit increases from 20% to 30% of total plan costs for an individual in 2014, do you expect to increase your incentives beyond the current 20 percent limit?

What are the 3 most effective steps you have taken or will take to control health care cost increases?

Source: National Business Group on Health, “Large Employers’ 2013 Health Plan Design Survey,” August 2012no periods in source lines

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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.