Performing well on some newly introduced HEDIS 2000 measures may be a real challenge for some health plans. The National Committee for Quality Assurance tells Managed Care that four HMOs field-tested the measure controlling high blood pressure, and compiled weak scores of between 32 and 42 percent.... PacifiCare of California has released publicly its second Quality Index, which measures performance of more than 100 physician groups.... A U.S. Senate committee has concluded that the medical field is lagging badly in its Year 2000 computer preparations. More than 90 percent of physicians' offices have yet to address the problem.... The American Association of Health Plans and the National Institutes of Health are trying to reach an agreement that would allow more HMO enrollees to participate in clinical trials. Billing issues arise when members want to join research-related activities.... Most private-practice physicians in British Columbia, Canada, walked off the job for five days last month after a government decision to reduce payments to them. "We're not being paid to work those days," one physician told a Canadian wire service.
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.