There are many ways to rank health plans. The Sachs Group, which thinks loyalty and satisfaction with member services tell a lot about a health plan, issued its third annual HMO Honor Roll, singling out plans for these attributes.

Sachs surveyed 97,000 consumers in 30 markets. Consumer loyalty, Sachs says, is important to a health plan's long- term viability. Sachs found that member services had the greatest influence on loyalty. Network access and medical management had less effect. The office-visit experience had no bearing on loyalty to an HMO.

For health plans, the findings are good news, because member services — claims handling, benefit explanation and so on --are areas HMOs can control. It also means members distinguish between loyalty to health plans and loyalty to physicians.

Those making the honor roll were tops in their markets in subscriber loyalty and satisfaction with member services.

Sachs Group's third annual HMO Honor Roll

Market Plan name
Boston Harvard Pilgrim Health Care
Cincinnati ChoiceCare Health Plans
Denver Kaiser Permanente-Colorado
Los Angeles Kaiser Permanente-California
Miami Blue Cross Blue Shield of Florida
Prudential HealthCare-South Florida
New York Physicians Health Services
Portland Kaiser Permanente-Northwest
Sacramento Kaiser Permanente-California
San Diego Kaiser Permanente-California
San Francisco Kaiser Permanente-California
Tampa Cigna HealthCare of Florida
Washington Kaiser Permanente-Mid-Atlantic
Prudential HealthCare-Mid-Atlantic
SOURCE: SACHS GROUP, EVANSTON, ILL., 1998

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.