Advance Paradigm will buy PCS Health Systems from Rite Aid Corp. for $1 billion — a third less than what Rite Aid paid for PCS last year.... In Massachusetts, supporters are working with the legislature on a compromise after gaining enough signatures to put a universal care proposal on the November ballot. But in Washington State, backers failed to qualify a similar initiative for the ballot.... Managed Medicare patients are more costly than patients in fee-for-service Medicare after a stroke, due to poor-quality acute care that leads to longer aftercare, according to a Journal of the American Geriatric Society study.... In a curious agreement, United HealthCare is signing over care for its 900,000 California members to Blue Shield, but it isn't leaving the state. One fourth will be transferred to Blue Shield, while the remainder will use Blue Shield's provider network. United wants out of the business of negotiating with providers in the state. Consumer advocates worry that because the deal isn't a full-blown merger, it escapes state scrutiny.
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.