No less than measuring and evaluating outcomes in disease management programs is the goal of a program launched by the Disease Management Association of America. "This certainly stands among the disease management community's most significant research efforts to date," says Don Fetterolf, MD, chairman of the DMAA Quality and Research Committee. "Reaching consensus on a relevant and scientifically valid standard for evaluating clinical and financial outcomes is vital to the continued strong growth of disease and care management." The DMAA hopes to unveil the new methodology in December. . . . The political wind seems to have shifted in Germany. There's further evidence that the election of Angela Merkel as German Chancellor might mean a turn toward the free market. German Health Minister Ursula Schmidt "startled" — that's the word used in one report — an American audience by saying she admires the managed care system in the United States and hopes to implant some of those ideas in her native land. . . . President Bush wants most Americans to have electronic medical records by 2014. However, a study in the Journal of American Medical Informatics projects that physician foot-dragging will slow adaptation considerably. Most Americans won't get EMRs until 2024, according to the study.
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.