MedPartners Inc., which made a fast fortune as the world's biggest physician practice management company, then lost it almost as quickly, changed its name to reflect the shift of its business to pharmacy benefit management. The company already owned Caremark, the PBM, so renaming itself Caremark Rx Inc. was a natural.... Tufts Health Plan will boost premiums 10 to 15 percent next year and leave Maine, thanks to a $30 million loss.... Aetna U.S. Healthcare, which has taken a PR beating from physicians, has created a unit dedicated to shoring up relations with its 250,000 contracted doctors.... The Pacific Business Group on Health chose open-enrollment season to name Blue Cross of California its 2000 Blue Ribbon health plan. PBGH's selection is based on outcomes, customer satisfaction, use of electronic health information, and willingness to collaborate with other stakeholders in health care.
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.