The National Institute for Health Care Management says more than two fifths of the 18.8 percent increase in outpatient drug spending from 1999 to 2000 was attributable to higher demand. A bit more than a third of the spending increase was linked to newer medications.... HMOs begin declaring this month whether they will stay in Medicare. HealthMetrix Research predicts withdrawals displacing 700,000 members.... "Everyone in health care hates HCFA," Julie Rovner wrote in Congress Daily/AM the same week HHS Secretary Tommy Thompson decided to run the agency for one week. Thompson wanted to see how "we can do things better," but a new identity wasn't what others had in mind; at the end of the week, Thompson was considering changing HCFA's name to the Medicare and Medicaid Association.... One of the more interesting proposals floating around Washington comes from Kenneth Cooper, M.D., the president's reported choice to become the next surgeon general: tax deductions for meeting personal health targets, e.g., for cholesterol and blood pressure. Did someone say "Privacy"?.... Mary Jane England, M.D., is leaving the Washington Business Group on Health this month to become president of her alma mater, Regis College.... Beginning July 1, San Francisco city workers will be entitled to sex-change benefits for surgery, hormone therapy, and counseling.
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.