Forcing Medicaid recipients in five of South Carolina's biggest counties to enroll in health plans is one of the provisions in a reform package state legislators are considering. The controversial measure passed in the state House, and is now making its way through the Senate.... Money is saved when asthma patients receive care from asthma specialists, according to a report issued by the American College of Allergy, Asthma & Immunology. Patients cared for by allergists are hospitalized less often for asthma symptoms and have shorter lengths of stay — resulting in lowering of the cost of inpatient asthma care by as much as 95 percent, the study says.... HMOs lost enrollees in record numbers in the year ending July 1, 2002, Reuters reports. About 4 million people dropped out of HMOs in that period, the largest year-over-year decrease ever.... It costs $423 more per year to treat privately insured obese people than it does to treat those who are normal weight, according to a new study in Health Affairs.
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.