Philadelphia's Jefferson Health System has threatened to drop Independence Blue Cross June 1 unless a new contract can be hammered out. Few expect that to happen — Jefferson makes up 20 percent of IBC's business, while the insurer means a quarter of Jefferson's revenue. But both sides sent letters to patients and members to frame the issues — a sign of how health systems are increasingly taking their disputes straight to the public.... Whether you're in an HMO or an indemnity plan, there's no difference in your likelihood of being hospitalized or having access problems, according to a Center for Studying Health System Change study. While that skewers the perception of HMOs as barriers to care, it raises questions about their ability to control costs.... The prospect of lower out-of-pocket costs is far more important to people who join Medicare HMOs than prescription-drug benefits, according to a study by the Office of the Inspector General... The Academy for International Health Studies has launched a feasibility study into a cross-border health plan that would cover people who work and live in the U.S. and their families living in Mexico.
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.