WellPoint and Cigna are turning heads in the financial world. Cigna's second-quarter earnings rose 73 percent from the same period last year to $720 million as its earnings kept well ahead of medical costs thanks to higher premiums and lower operating costs, reports the Wall Street Journal. Meanwhile, the newspaper says that WellPoint's earnings are expected to rise 15 percent a year for the next five years.... California health insurers have marked Jan. 1, 2007 on their calendars. That's when the state is expected to move more than a half-million recipients of Medicaid (known as Medi-Cal in that state) into managed care. Gov. Arnold Schwarzenegger sees the move as an important part of curbing soaring costs. Critics counter that only mass confusion will ensue, and the sought-after savings will not appear.... Transparency is key, according to a plan by a coalition of 52 employers that outlines how they want PBMs to conduct business. PBMs would have to give to their clients the drug company rebates that now often go to the PBMs, according to the Wall Street Journal. In addition, PBMs would have to disclose the acquisition costs for retail and mail-order drugs. So far, only three PBMs have agreed to the terms outlined by the employer coalition, HR Policy Association. Those PBMs: Aetna Pharmacy Management, MedImpact Healthcare Systems, and Walgreens Health Initiatives.... "Preventive care services" means different things to different health insurers, says a recent report in the Wall Street Journal. The article quotes Andrew Baskin, Aetna's senior medical director, as blaming the problem on a lack of a universally accepted standards. "There is no industrywide definition here," says Baskin, "so each insurer has the ability to define preventive services for [itself]." Patients can have a tough time trying to figure out, for instance, just what drugs are covered by an insurer as a preventive treatment.
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.