Medicare pullouts for 2000 are mounting. Sentara plans to drop the Norfolk, Va., area's only Medicare+Choice plan next year. Harvard Pilgrim will abandon western Massachusetts, and HIP will leave Tampa.... Contraception coverage is a big state-level issue. Georgia, Hawaii, and Vermont passed coverage mandates this year; 28 states and Puerto Rico are considering them.... The AMA lost $5.4 million in 1998, a year in which it spent $16.6 million (fifth in the U.S.) on lobbying. When it pumped $8 million into lobbying in '97, AMA was the biggest spender in the nation.... The Foundation for Accountability is analyzing test results of its children's quality-of-care measures. It will ask National Committee for Quality Assurance to include them in HEDIS in 2001.
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.