Speaking of Medicare+ Choice, HCFA issued an operational policy letter explaining how some reimbursement models will adapt to the new structure. The Balanced Budget Act eliminated prepayment plans, which provide only Part B benefits, and medicare risk contracts after this year, and cost contracts by 2002. Current cost contractors that also have a prepayment agreement may move members into cost contracts with HCFA approval.... President Clinton's proposed 1999 Veterans Affairs budget includes a $17 billion cut in health care spending. In past years, the VA health care budget has increased $1 billion annually. The Clinton administration does not want to spend money on vets who claim their illnesses resulted from smoking.... Even with Medicare, senior citizens spend almost one-fifth of their incomes on health care. According to a report by the American Association of Retired Persons, Medicare recipients shelled out an average of 19 percent of their incomes, or $2,149, for health care in 1997.... The Department of Health and Human Services has kicked 1,400 health care professionals out of Medicare and Medicaid for defaulting on federal health education loans. A list of those disqualified is posted on the Internet at http:// www.defaulteddocs.dhhs.gov and is updated regularly.
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.