A California Medical Association examination of HMOs' expenditure data found that Health Plan of the Redwoods and Kaiser Permanente Northern California spent 96.5 cents of each premium dollar on care in fiscal 1998 — highest in the state. Both lost money; HPR and Kaiser, respectively, spent 11.7 and 3.6 cents on administration.... HMO premiums in Illinois rose 5.4 percent, but HMOs lost an average of 1.6 percent of revenues in 1997, according to a report by consultant Allan Baumgarten.... Dental HMO enrollment rose 5 to 8 percent during 1998, while dental PPO enrollment shot up 30 to 35 percent, says the National Association of Dental Plans.... Medicare claims must now be Year-2000 compliant.... California officials and MedPartners reached an agreement where the latter will fund its physician practices until they are sold.... The AMA has chosen not to form a physician union, for now.... A Journal of Family Practice study demonstrates better outcomes for the poor when care is coordinated by a primary-care physician.
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.