Health plans appear to be having some trouble fulfilling a federal mandate that 80 percent of questions from Medicare beneficiaries about pharmacy coverage be answered within 30 seconds. The fast-approaching deadline for enrolling in a Medicare drug plan may be partly to blame. "The large amount of interest in our prescription drug plans, as the May 15 deadline approaches, means that the wait times are longer than we would like," says Humana spokesman Thomas Noland. . . . New standards that rate insurers on measurement of physician and hospital quality and the degree to which the insurers act on the results received the backing of more than two dozen of the nation's largest employers. The National Committee for Quality Assurance will begin surveying plans on July 1.
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.