Lobbying organizations representing small businesses are divided over association health plans (AHPs), and that amounts to a serious drawback in Washington, D.C., where it always pays to speak with one voice. AHPs would allow businesses with fewer than 200 employees to band together into purchasing consortiums. Two lobbying groups, the National Federation of Independent Business and the National Association for the Self-Employed, stand foursquare in favor. However, the National Small Business Association is against AHPs.

Legislation allowing AHPs has made it through the House before, but not the Senate. President Bush insists that AHPs would work by allowing small companies to skirt hundreds of state regulations and mandates currently in place.

The NSBA counters that AHPs would not so much create savings as segment risk by attracting healthier rather than sicker employees.

"The insurance industry competes based largely upon each company's ability to attract healthier participants," says the NSBA, which has about 150,000 members. "AHPs are likely to pattern that behavior and build insurance programs that are unattractive to older and sicker populations. This type of risk selection would lead to a drastically segmented market, with the healthy population gaining health care at a cheaper rate and the unhealthy population watching ... insurance premiums increase out of reach."

On the other hand, the National Federation of Independent Business, with 600,000 members, says AHPs would reduce the number of uninsured and provide affordable coverage.

The National Association for the Self-Employed, with 250,000 members, says that AHPs would lower insurance costs by introducing more competition into certain markets.

They would offer small businesses the same opportunity currently enjoyed by unions and large companies.

The NASE is urging its members to tell "your senators that you must have relief in the form of association health plans to be able to retain qualified workers and help grow the economy."

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.