Update your scorecards: Indiana-based Anthem is buying Blue Cross-Blue Shield of Maine, Altius took Intergroup of Utah off of Foundation's hands, and ConnectiCare is buying that state's chunk of Kaiser Permanente's Northeast empire.... Health Plan of Nevada wants to cut costs for two antidepressants and a cholesterol reducer by cutting pills. HPN asked members to buy high-dose tablets and divide them in half, and mailed them pill splitters. It told physicians to prescribe double-strength meds.... HMO penetration in large markets advanced an average of 2 percentage points from 1997 to 1998. The average penetration rate for smaller markets dropped, according to InterStudy Publications.... Don't think employers will take rate increases lying down. Several members of the Pacific Business Group on Health say they will freeze enrollment in plans asking for double-digit rate hikes without proof of better service.... The Robert Wood Johnson Foundation extended the Partnerships for Quality Education, which brings together medical schools and HMOs, with an $8.9 million, four-year grant.... A long way from Ellwood's vision: A new Florida law prevents providers from signing exclusive arrangements with HMOs.
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.