Not much dissent on this one. The Senate voted 95–0 on Oct. 14 to approve a bill that would mandate that employers and insurers not discriminate against individuals based on their genetic information.... New labor contracts between the Big Three auto manufacturers and the UAW require that union members and retirees purchase prescription drugs for chronic illnesses by mail. The companies hope to save several hundred million dollars a year.... Anthem hopes coupons will help reduce expenditures for medication. The Blue Cross Blue Shield plan is making an effort to steer members away from brand-name drugs by offering coupons for a 20- to 28-day free trial of generic prescriptions. The program is under way in 7 of the 9 states the health plan serves.
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.