The push for health savings accounts (HSAs) continued as managed care plans and employers were given more guidance by the Treasury Department on just what those products may cover. New guidelines, issued March 30, say that the HSAs may be used to cover some preventive services and prescription drugs.

Managed care organizations had been awaiting further guidance on HSAs ever since they became law on Jan. 1 as part of Medicare reform.

Under the HSA program, members and employers may set aside money tax-free, either individually or through joint contributions. HSAs are available to members of health plans who have an annual deductible higher than $1,000 for an individual and $2,000 for a family.

Insurance linked to HSAs requires that consumers pay the deductibles first. However, the new guidelines exempt some preventive care services from that rule. They include obesity treatment, annual physicals, and smoking-cessation programs.

"We want to make it easier for those designing HSAs to comply with the rules and help consumers understand how HSAs can help them meet their health care needs," says Gregory Jenner, acting assistant treasury secretary, who adds that he wants the new guidelines to help "make HSAs available to all consumers as quickly as possible."

Unlike medical savings accounts, HSAs aren't focused on small companies and the self-employed. Anyone may participate: big companies, medium-sized outfits, small firms, and the self-employed.

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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.