All 50 states and the District of Columbia had begun enrolling youngsters in the Children's Health Insurance Programs (CHIP) by last December, swelling the ranks of those insured under the program to 2.7 million.... A study funded by the Centers for Disease Control and Prevention says that only 25 percent of adults reported being encouraged by their doctors to exercise.... A recent report by the Institute of Medicine seeks to dispel some misconceptions about the uninsured, pointing out that 80 percent of that population is in "working families" and that immigrants make up only a small percentage of that number.... A survey of medical groups in California found that 44 percent of 250 reporting risk-bearing organizations met all of the financial solvency standards of the California Department of Managed Health Care. An organization representing medical practices asserted that the study used flawed methodology.
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.