Today's News and Commentary

About health insurance

Large Employers Double Down on Efforts to Stem Rising U.S. Health Benefit Costs which are Expected to Top $15,000 per Employee in 2020: The National business Group on Health polled its members about how they will deal with the projected 5% increase in healthcare costs next year. “Employers identified implementing more virtual care solutions (51%) and a more focused strategy on high cost claims (39%) as their top initiatives for 2020. The survey also found that managing prescription drug benefit costs remains a high priority for employers in 2020.” Further, “ 49% of respondents plan to pursue an advanced primary care strategy in 2020, and another 26% are considering one by 2022…The number of employers offering full replacement consumer-directed health plans will shrink to 25% in 2020, down from 30% this year and 39% in 2018. Instead, employers will offer more plan choices like a preferred provider organization (PPO) plan.”

Use of Pharmacy Benefit Managers and Efforts to Manage Drug Expenditures and Utilization: The Government Accountability Office examined “the role of PBMs in the Part D program. This report examines, among other objectives, (1) the extent to which Part D plan sponsors use PBMs, (2) trends in rebates and other price concessions obtained by both PBMs and plan sponsors for Part D drugs, and (3) how PBMs earn revenue for services provided to Part D plans.” Among its findings: “PBMs primarily earned Part D revenue through a volume-based fee paid by plan sponsors based on PBM-processed claims; a per-member, per-month fee paid by plan sponsors; or a combination of the two. PBMs also earned revenue from the rebates they negotiated with manufacturers for Part D drugs, which accounted for $18 billion of the $26.7 billion in rebates in 2016. PBMs retained less than 1 percent of these rebates, passing the rest to plan sponsors. Plan sponsors in turn may use rebates to help offset the growth in drug costs, helping control premiums for beneficiaries.”

Where Tourism Brings Pricey Health Care, Locals Fight Back: Because local residents of this Colorado tourist town could not afford the local hospital’s charges, they created an alliance plan whereby members could obtain 30% discount off published charges. A related comment: purchasing power is an important tool to lower healthcare costs. That is why employer-sponsored insurance remains a viable option.

About the public’s health

Treating Parents for Tobacco Use in the Pediatric Setting: Improving care can be about the setting/context as much as the message. “In this trial, integrating screening and treatment for parental tobacco use in pediatric practices showed both immediate and long-term increases in treatment delivery, a decline in practice-level parental smoking prevalence, and an increase in cotinine-confirmed cessation, compared with usual care.”

Association of Intensive vs Standard Blood Pressure Control With Cerebral White Matter Lesions: What is an appropriate target for systolic (the “upper number”) blood pressure control? This research used brain imaging measures and concluded 120 was better than and older target of 140.

Public Comment on Draft Recommendation Statement and Draft Evidence Reviews: Screening for Illicit Drug Use, Including Nonmedical Use of Prescription Drugs: Many media outlets reported that the US Preventive Task Force recommended screening all adults for illicit drug use. The reporting was not quite correct, reinforcing that going to the original source is important. While “The Task Force found that clinicians should screen all adults for illicit drug use [and] More research is needed to make a recommendation for teens,” these were part of a draft recommendation statement open for comment until September 9.

Evaluation of the Cascade of Diabetes Care in the United States, 2005-2016: Control of blood sugars, lowering high cholesterol levels and blood pressure, and eliminating smoking are all important in mitigating the long term effect of diabetes. However, these researchers found that these factors have not improved significantly between 2005 and 2016. These gaps in care particularly affect “younger adults (18-44 years), women, and nonwhite individuals…” Another instance of knowing what to do but not doing it.

Roles of cyberbullying, sleep, and physical activity in mediating the effects of social media use on mental health and wellbeing among young people in England: a secondary analysis of longitudinal data: Adverse behavioral outcomes from excessive social media exposure is a recognized problem. Why it occurs and what to do about it are not always clear (other than cutting out use entirely). Researchers found that mental health “harms related to very frequent social media use in girls might be due to a combination of exposure to cyberbullying or displacement of sleep or physical activity, whereas other mechanisms appear to be operative in boys.” Clearly solutions need to be tailored, especially by gender.