Don't expect Rep. Tom Campbell's bill granting collective-bargaining rights to health care professionals to get far, despite its 26–2 romp out of committee. House GOP leaders aren't enthusiastic about the bill, but sources told the Associated Press that Speaker Dennis Hastert promised Campbell a floor vote in exchange for his support of a GOP tax-cut measure.... Medicare+Choice plans have long complained about minimal payment increases, and 2001's capitation hikes didn't change that. Most will get a 2-percent boost next year, while those in floor counties will see a 3.3-percent increase .... CalPERS settled on an average 4.9-percent premium increase for 2001, far less than anticipated by some. Two days later, it delayed implementing its cornerstone for holding rate increases down — doubling pharmacy copayments — when unions raised a stink.... Blue Cross and Blue Shield of Massachusetts quit the state's HMO association. A Blues executive told the Boston Globe that the association is "against things. We're for things."
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.