Financial analysts warn against judging FPA Medical Management's slide into bankruptcy as the general direction of the physician practice management industry. Said one, wide variations in business strategy make generalizations unrealistic. The consensus about FPA is that it grew too fast. FPA has fallen hard; its stock price, which was around $40 a share last fall, hovered below 20 cents in August.... Jay Gellert has succeeded the retiring Malik Hasan, M.D., as CEO of Foundation Health Systems. Hasan will remain chairman of the board until early next year.
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.