Employers can save a lot of money by moving some or all of their workers from traditional coverage into a consumer-directed health plan (CDHP), and companies are doing just that, says a study by Mercer, the large consulting company. “The cost of coverage in a CDHP with a health savings account is about 20 percent lower, on average, than the cost of PPO coverage — $7,833 per employee compared to $10,007,” according to the National Survey of Employer-Sponsored Health Plans.

Employee enrollment in CDHPs jumped from 13 to 16 percent of all covered employees in 2012. “Over the past two years, offerings of CDHPs have risen from 17 to 22 percent of all employers, and from 23 to 36 percent of employers with 500 or more employees. Well over half (59 percent) of very large organizations (20,000 or more employees), which typically offer employees a choice of medical plans, now offer a CDHP.”

CDHP enrollment grows sharply in 2012

Percentage of all covered employees enrolled in each plan type

Sharp increase in CDHP offerings by large employers

Percent of employers offering/likely to offer CDHP, by employer size

Source: Mercer’s National Survey of Employer-Sponsored Health Plans

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.