The AMA has asked the U.S. Department of Justice to block Aetna's planned purchase of Prudential's health care lines, calling it anticompetitive. The association and Aetna have been squabbling over language in physician contracts, but with Aetna soon to be in control of an eighth of all managed care lives, it will be harder for most physicians to refuse.... Health Options, a subsidiary of Blue Cross Blue Shield of Florida, has acquired 150,000-member Principal Health Care of Florida.... Aetna U.S. Healthcare has instituted a system for external review of coverage denials.... Kaiser Permanente is offering a benefits package providing coverage for domestic partners.... A growing number of plans are adding alternative-care benefits. Blue Cross and Blue Shield of Hawaii will soon begin covering acupuncture, naturopathy, chiropractic care, and massage. And PacifiCare of Oregon has contracted with Complementary Health Plans, an alternative-care PPO, to serve PacifiCare members.
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.