Originally touted as an affordable way to expand insurance coverage to more people, high deductible insurance plans paired with health savings accounts (HSAs) are not working out that way. A report from the Government Accountability Office (GAO), the investigative arm of Congress, has found that HSA enrollees were much wealthier than people who were covered by other types of plans, based on tax returns from 2005. The report raises questions about who selects these plan types and how they use the accounts.

Tax filers who reported HSA activity in 2005 had higher incomes on average than other tax filers. The average adjusted gross income for filers reporting HSA activity was about $139,000, compared to $57,000 for all other filers.

Proponents say the low premiums of HSA-eligible plans and the tax-free savings of HSAs appeal to many consumers, while the high deductibles encourage them to be better health care consumers.

But critics say that HSA-eligible plans may attract enrollees who seek lower premiums but lack the resources to contribute to an HSA. HSAs may also attract wealthy enrollees who may seek to use the HSA primarily to accumulate tax-advantaged savings rather than pay for medical expenses.

HSAs are clearly attractive to high-income people, “but they aren’t the answer for providing adequate health-insurance coverage for average Americans,” says Rep. Henry Waxman, a Democrat from California, who requested the report from the GAO.

These plan types do have a following as the number of individuals participating in HSA-eligible health plans and HSAs increased significantly, going from 438,000 covered lives in September 2004 to an estimated 4.5 million covered lives in January 2007.

However, throughout those years, more than 40 percent of eligible people did not open an HSA. Why?

“It’s a matter of affordability. Consumers may purchase the high deductible plans with low premiums but they may not have money set aside for HSAs or they may feel that they don’t need the account,” says John Dicken, a director of health care in the GAO.

Getting the word out about HSAs and high deductible health plans is a role insurers can play.

“A key point in having consumers effectively manage their health care is to provide information about the cost and quality of services. In our focus groups with HSA users, they’ve indicated that they’re not using that type of information and feel that the information is limited,” says Dicken.

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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.