Enrollment in national HMOs operating in two or more states grew by 14.6 percent, while the number of such companies dropped by 17.4 percent over the last five years, says InterStudy Publications. It's a sign of mergers, acquisitions, and consolidations in the industry.... Pharmaceutical companies employ 81 percent more people in their marketing departments than in their research and development departments, according to a survey by the Boston University School of Public Health.... Forty-three percent of the elderly who lack prescription drug coverage and who are minorities, have annual incomes of less than $10,000, or have out-of-pocket prescription drug costs of greater than $100 a month say they restrict their use of medication because of cost, according to the University of California-San Francisco Department of Medicine.... The American College of Physicians-American Society of Internal Medicine has called on Congress to enact universal coverage. ACP-ASIM is seeking input on a proposal that would implement it, incrementally, over seven years.
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.