Now there's discussion of something called "metabolic syndrome," which seems to include all the problems associated with being obese. An article in the Washington Post notes that some experts are also a bit skeptical, saying that a diagnosis of metabolic syndrome may lead doctors to rush patients into drug treatment without giving dieting and exercise a chance.... Aetna has introduced six PPOs in Connecticut (where the company is based) that are aimed at the state's uninsured and others who don't have employer sponsored health insurance. Members will be able to go out of network but will pay more out of pocket to do so, says the Hartford Currant. Those who remain in-network will not have to pay deductibles for physician visits and generic prescription drugs.... It's nearly impossible to determine whether hospital infections are rising or falling, according to the Wall Street Journal. "Infection fighters on the front lines say the situation isn't nearly as simple as consumer advocates make it seem. Hospitals don't have some 'infection rate' that they know but are keeping secret. Instead, there is no standard method" for keeping tabs on infections.... Technology sometimes creates problems as well as solves them. The Jan. 3 issue of Health Care Policy Report: "Computerized drug prescribing mistakes accounted for nearly 20 percent of all hospital and health system medication errors in 2003, a study released by the United States Pharmacopeia (USP) said. "
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.