A survey of 200 pharmacies in Detroit and some surrounding suburbs finds that inner-city patients have a much tougher time obtaining painkillers. "The same drugs that reduce suffering of cancer patients are coveted by illicit [drug] users for their massive highs, making drug stores targets for break-ins," reports the Detroit News, which conducted the survey. Some pharmacists have concluded that stocking the drugs isn't worth the risk.... Meanwhile, what may be a major reason for rising health care costs is utilization by those who are called the "worried well," people who see many health stories on a variety of media outlets. About 16 percent of U.S. residents had 11 doctor's visits and medical tests in 1997. That figure climbed to 22 percent in 2002, according to ABC news.
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.