Humana reported that its congestive heart failure disease management program, run by Cardiac Solutions, reduced inpatient expenses 61 percent.... Sierra Health Services finished its acquisitions of Kaiser Foundation Health Plan of Texas and Kaiser's Texas Permanente Medical Group. Sierra renamed the HMO Texas Health Choice.... Kaiser, meanwhile, said that its California arbitration system will now be independently administered by a Los Angeles law firm.... Seems Oxford Health Plans may be inching closer to recovery, losing only $47 million in the third quarter.... And Foundation Health Systems reported an $88 million Q3 loss. Also Cora Tellez has been named chief executive at Foundation subsidiary Health Net, after Arthur Southam resigned under pressure last month.
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.
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?
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.
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.