Expanded Medicare coverage for obesity is the result of the government's removal of language from the Medicare manual that states that the condition is not an illness. Although the Department of Health and Human Services stopped short of calling obesity a disease, the move will give Medicare leverage concerning what can be covered. "With this new policy, Medicare will be able to review scientific evidence in order to determine which interventions improve health outcomes for seniors and disabled Americans who are obese and its many associated conditions," HHS Secretary Tommy Thompson announced last month.... Earnings soared 36 percent for UnitedHealth Group in the second quarter. The company reported net income of $596 million.... The percentage of children who are uninsured decreased in 2003 to the lowest level ever, according to a survey by the CDC's National Center for Health Statistics.
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.