Consumer reaction against managed care appears to be easing up, according to a recently released national survey that says that not only are patients willing to accept more restrictive health plans, but they understand why such measures are necessary. The California HealthCare Foundation says that in order to control rising costs, 54 percent of respondents would accept using less expensive drugs, 52 percent favor having to go through a gatekeeper to see specialists, and 43 percent would accept prior approval for new and/or expensive treatments. These were all features of managed care that, until recently, were reasons patients cited for being dissatisfied with the system.

"The managed care backlash is easing up, probably because consumers are feeling the pinch of rising costs themselves," says Claudia Schur, principal research scientist at the National Opinion Research Center at the University of Chicago, which conducted the study for the CHCF. "However, support for managed care practices is quite segmented, depending on each consumer's health care experience and needs. As a result, we may see more plan offerings where consumers who want choice can pay for it, while those willing to accept limits on their care can pay less."

The survey was conducted by phone in August and includes responses from more than 2,000 adults nationwide. The findings show that the trade-offs that someone will accept between keeping costs down and having more restrictive benefits depend on where that person fits in the socioeconomic order.

"Wealthier consumers in bad health were most resistant to restrictions on their care, while low-income people in bad health were much more likely to accept such restrictions, presumably because of their limited ability to pay," says the CHCF.

Younger and healthier people — those who have grown up with managed care — were more willing to accept common cost containment practices such as specialist referral.

Meanwhile, a survey by the Blue Cross and Blue Shield Association finds that health care should be one of the top items on the new Congress's domestic policy list. A poll of 1,000 people conducted Nov. 4, 6, and 7 finds that 40 percent of consumers see health care and prescription drug costs as two issues that should be top priorities for lawmakers.

BCBSA President and CEO Scott P. Serota believes that putting the focus on quality may be the way to help rein in costs and create a better health care system.

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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.