The disease management industry worries about a bill sent to California's governor that would allow medical information to be shared only when a physician authorizes DM services.... The American Osteopathic Association won't follow the AMA's lead. It voted not to form a doctor union.... In Washington, where insurers have been dropping individual policies, only one carrier next year will sell the state's Basic Health Plan. Other insurers have frozen enrollment or quit the program, designed for people without employer benefits.... Delaware will use its share of the national tobacco settlement to fund $2,500 in annual prescription coverage for low-income elderly and the disabled without it.... The Society of Actuaries has made odds on Uncle Sam developing a government-payer system in the next 10 years: 1 in 3.
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.