Good news for government workers enrolled in the Federal Employees Health Benefits Program. Premiums are expected to increase 7.9 percent next year. This after five consecutive years of double-digit hikes.... PPO demonstration projects for Medicare in 2001 and 2002 may have benefited by CMS officials exceeding their legislative authority, according to a General Accounting Office report. Apparently, former CMS Administrator Thomas Scully stepped over the line in having Medicare take most of the risk if costs for Medicare beneficiaries were higher than PPOs anticipated.... A class-action lawsuit filed by 900,000 physicians could mean financial disaster for the managed care industry, according to lawyers representing insurers who are alleged to have systematically underpaid the doctors. The 11th Circuit Court of Appeals says the doctors may sue as a group, rather than have to sue the insurers individually. Health plans involved are: Health Net, Humana, PacifiCare, Prudential, UnitedHealthcare, and Wellpoint.... Seventy-eight percent of the country wants universal health care similar to what exists in Canada and Great Britain, according to a survey by the Civil Society Institute. Further, about one-third of the 1,020 people surveyed say that they were already or would consider buying medication from Canada or other countries.
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.