More employers want to offer consumer-directed health plans, according to the Aon Hewitt 2013 Health Care Survey. It’s one way to shift more costs to workers and some employers will use the Affordable Care Act to help with this. The insurance exchanges will give adult dependents — spouses and older children — another means to obtain coverage. “Further, we expect to see continued design-based cost sharing. In doing so, employers will increasingly embrace CDHP approaches, including full-replacement models [offering no other plan options]. We believe CDHP approaches are most successful when simultaneously aligned with programs and incentives aimed at improving health.”

Employers who are considering CDHPs are interested in both health reimbursement accounts (HRAs) and health savings accounts (HSAs).

“More than one-third of employers (40%) offer an HSA with an employer contribution to the HSA today; another 42% are considering it for the next three years. Fourteen percent of employers offer an HSA-eligible plan, but do not fund the account. Twenty-three percent offer an HRA with employer funds in the HRA, another 33% are considering it for the future.”

The data were collected in interviews conducted in December 2012 and January 2013 with more than 800 employers. More than half of the respondents have operations outside of the United States.

Shift to consumer-directed health plans continues

Source: “Aon Hewitt 2013 Health Care Survey”

How do consumers feel about CDHPs? Aon Hewitt asks this in another study, “The Consumer Health Mindset: Turn Good Intentions Into Great Outcomes,” and sees that enthusiasm waned somewhat last year, though one shouldn’t read too much into that. “Even though CDHP satisfaction has slipped, 89% of consumers who are currently in a CDHP and have a choice of plans expect to re-enroll in this type of plan. This expectation is especially true for those who have been in a CDHP for more than two years. Ninety-seven percent of this group plan to re-enroll in a CDHP.”

How satisfied are you with your CDHP?

Source: “The Consumer Health Mindset: Turn Good Intentions Into Great Outcomes”

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.