The amount the U.S. spends on health care will reach $4 trillion, or about 20 percent of gross domestic product in 2015, according to a report by the National Health Statistics Group, a division of the Centers for Medicare & Medicaid Services.

The NHSG report, a Health Affairs Web exclusive, further estimates that health care spending per capita will reach about $12,320 in 2015. In 2005, health care spending per capita was $6,683.

In addition, the report finds that private health insurance spending increased by 6.8 percent in 2005, compared to 8.4 percent in 2004; hospital spending will double by 2015; and home health spending, about $49 billion in 2005, will increase to $103.7 billion in 2015. Prescription drug spending is expected to reach $446 billion in 2015. It was $188 billion in 2004.

These daunting statistics represent a challenge to policymakers. In its coverage, the Los Angeles Times says the Bush administration response is inadequate. The Times led its Feb. 22 story with "Health care will account for 1 in 5 dollars spent in the United States by 2015, and health savings accounts are unlikely to help much in containing costs. . . ."

HSAs are a big part of the administration's health reform package. By allowing participants to save money tax-free for health expenses, it is hoped that they will encourage enrollment in consumer-directed health plans. But, as the Times reports, so far only about 3 million Americans, or less than 2 percent of those in private health plans, are in plans that include HSAs.

Sheila Smith, an economist and coauthor of the Health Affairs report, tells the newspaper that "Given the small number of people affected, we don't expect the effect to be huge."

NHSG Deputy Director John Poisal tells Long Island Newsday that "We don't expect HSAs to proliferate so dramatically that we would have an impact similar to that of the managed care era of the '90s."

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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.