A new rule by the Treasury Department is supposed to make flexible spending accounts more attractive, but stops short of creating the kinds of FSAs that experts have long said will attract millions of people.

The Treasury Department has, in a sense, made the year 21Ž2 months longer for those who have FSAs. Enrollees get the extra time to spend what's left in the FSA or to lose it — a big step, to be sure, but still far short of allowing FSAs to accrue indefinitely. FSAs are the oldest health spending account and employers have been fighting against the use-it-or-lose-it rule for years.

Bonnie B. Whyte, president of the Employers Council on Flexible Compensation, told Managed Care last year that the use-it-or-lose-it rule "is just downright dumb. It acts as a real deterrent for people participating in FSAs."

About 22 million workers have the option to use FSAs, though only 7 million do so, according the council.

"Rather than spending the money before New Year's Day, you'll have it until March 15," Joe Martingale, a health care strategy expert at Watson Wyatt, tells USA Today.

Treasury Secretary John Snow told the Wall Street Journal that the extra 21Ž2 months, "will ease the year-end spending rush prompted by the prior rule," which stated that employees with FSAs had to use up the entire account by the end of the year. Many workers, the paper said, go into a buying frenzy mode in which they "scramble to stock up on eyeglasses, aspirin, and other items in order to drain their accounts by the deadline."

This problem has not escaped legislators' notice. Two senators, Republican Jim DeMint and Democrat Ken Salazar, are proposing legislation that would allow, according to the WSJ, "as much as $500 of unused FSA funds to be carried forward to use in the next year, or [to be] contributed to a health savings account."

An editorial in the May 23 edition of the Washington Post applauds the move. "It makes sense to put money in health care spending accounts, because you can pay your expenses with pretax dollars," says the newspaper. "But because these accounts are set up on a use-it-or-lose-it annual basis, guessing too high is dangerous: At year's end, you've either lost the money, which goes to your employer, or you scramble to spend it on things you might not need. Why not get that extra pair of glasses if the money's going to disappear otherwise?"

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.