What goes around comes around. At least that's what critics of the pharmaceutical industry seem to be saying as they gloat over reports that Novartis wants its employees to use more generic and over-the-counter medications. The brand-name drug maker also wants its workers to use mail order pharmacy more to "control the escalation of costs," according to a memo reportedly sent to employees by the CEO, Paulo Costa....Think that employers aren't getting more eager to find some sort of solution to rising health care costs? Then you missed the story about General Motors jolting Wall Street last month with the announcement that it would reduce its 2004 earnings forecast to $6 to $6.50 a share from $7 a share. And what did Rick Wagoner, GM's chairman and CEO, cite as the cause for the adjustment? Do you even have to ask? "These continuing large increases in health care costs put GM, and many other U.S. businesses, at a significant disadvantage," Wagoner tells the Wall Street Journal.
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.