Health plans blame prudent layman laws for an upsurge in ER visits in the last two years. American Medical News states that Aetna U.S. Healthcare, Cigna, and Humana all report double-digit increases in ER volume, while United Healthcare has charted a 20-percent jump.... PacifiCare will reduce its reliance on Medicare and put more emphasis on prescription drug management to help itself out of its doldrums .... Smaller PPOs' discounts for primary care networks average 29.1 percent, while national PPOs get an average 37.5-percent discount, according to InterStudy Publications.... The most cost-effective strategy for colorectal cancer screening is annual fecal occult blood testing plus sigmoidoscopy every five years, says a study in the Journal of the American Medical Association. ... Physicians in staff- and group-model plans tend to view guidelines and formularies as tools that ease practice, while independent physicians largely view them as making their jobs harder, according to an Archives of Internal Medicine report.
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.