About 50 of the largest U.S. employers plan to form a health insurance pool for about 4 million part-time, temporary, and contract employees who lack coverage. The pool will also cover early retirees and former employees who have exhausted their COBRA coverage, as well as children of employees who are students but no longer qualify for coverage. Aetna, Cigna, and UnitedHealth Group are vying to administer the plan.... Managed Medicare plans will receive at least a 6.6 percent increase in payment rates in 2005. That, added to the 10.3 percent increase this year, means that an additional $1.3 billion over two years will be pumped into the system. Federal officials hope that the increased funding will help plans to expand their Medicare Advantage coverage.... The biotechnology industry, which, thanks to heavy spending on research and development each year, has never seen an overall profit, may get there by 2008, according to Ernst & Young. The financial analyst says that publicly listed biotech companies in the U.S. should produce an aggregate net income of about $400 million in 2008, on revenues of about $91 billion.
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.