The least insured of the major medical services is the pharmaceutical benefit, according to the Pharmaceutical Research and Manufacturers of America. A PhRMA report says that for those under 65 who had health coverage in 2000, private insurance paid 60.2 percent of the cost of prescriptions while patients paid 37.2 percent. More than 70 percent of the cost of hospital, physician, and emergency care was covered by private plans.... Fraudulent insurance providers operate in every state and that's just further evidence of how the number of these "entities" has been growing in recent years, according to the General Accounting Office. They've left $253 million in unpaid medical claims between 2000 and 2002, only 21 percent of which have been recovered.... The newly merged American Association of Health Plans and the Health Insurance Association of America unveiled its new name March 9, which means industry officials are probably already used to addressing questions and concerns to America's Health Insurance Plans. Karen Ignagni, former head of the AAHP, is the AHIP's president and CEO.
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.