UnitedHealth Group provides a desirable service to providers in a pilot program in which patients who don't pay medical bills on time will have the money deducted from their paychecks or health savings accounts. The insurer says that it is offering a convenient way for consumers to pay deductibles and copayments to providers in an age in which there always seems to be another form to fill out. But if consumers are delinquent, UnitedHealth will charge interest at the prime rate.

As the Wall Street Journal puts it: "Under the new program, dubbed 'OnePay,' UnitedHealth will pay a patient's portion directly to a provider as soon as it processes an insurance claim. Then it will collect from the patient, with payment due in 20 days. If patients can't pay 100 percent of their portion right away, UnitedHealth will act as a creditor, steadily receiving payments, plus interest, that are deducted from the patients' paychecks until the bill is paid in full."

UnitedHealth's program, being launched in Texas, is voluntary. Even if patients react a little warily, providers and employers, as might be expected, are excited. Tenet Healthcare, which is participating, is willing to accept discounted payments at its 14 Texas hospitals from participating companies or patients.

"Any sacrifice we would make would be offset by the gain we would get on those additional collections," Stephen Mooney, Tenet's vice president for patient financial services, tells the Journal.

Tenet participates as an employer, as well as a provider, offering OnePay to its workers. The same goes for UnitedHealth and for its Texas employees.

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.