Aetna's profits more than doubled in the fourth quarter of 2003, rising to $249.5 million, or $1.56 a share, from $98.2 million, or 63 cents a share a year earlier. The insurer attributes the results to its ability to hold the line on medical costs and cut operating costs.... U.S. health care spending increased to $1.7 trillion last year, more than $5,800 for every American, according to a study in Health Affairs. A staggering number, to be sure, yet some take heart in the fact that the rate of spending is actually slowing, to 7.8 percent in 2003, from 9.3 percent in 2002 — the first decrease in six years.... Online enrollment of workers for health care benefits has exploded to the point where now a sizeable majority of employees at large companies sign up this way, according to Hewitt Associates. Seventy-seven percent of workers at companies with an average of 5,000 employees will use the Internet to enroll this year, says the consulting company.
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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.