Mexican immigrants are getting a chance to obtain benefits thanks to a program by Blue Cross of California that allows aliens to apply for health insurance by using their identification cards. "We have a health care crisis because there's too many uninsured using the system," says Michael Chee, a Blue Cross spokesman. "We would rather have them insured and paying into the system than draining the system." California has long been dealing with the problem of the uninsured.... Medical errors that stem from illegible handwritten prescriptions would be drastically reduced by a nationwide e-mail prescription system, according to a report by a company called eHealth Initiative. It argues that such a system would save the nation about $29 billion annually.... It could have been a contender, but instead it's just another merger that didn't quite come off. WellChoice's bid for Oxford Health Plans collapsed April 22. If the merger had happened, it would have created one of the biggest MCOs in the Northeast. Experts speculate that WellChoice may itself become object of an acquisition attempt.... Though HMOs continue to see the highest year-to-year premium increases, the plans remain the best bargain of the major health insurance products offered, according to a new Towers Perrin survey. Of course, after five years of double-digit increases, no one is particularly eager to throw the word "bargain" about.
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.