Although it was stable in the mid-1990s, the proportion of physicians without any managed care contracts rose from 9.2 percent in 2000–2001 to 11.5 percent in 2004–2005, according to a report by the Center for Studying Health System Change.

"This small, but significant, increase could signal a trend toward greater out-of-pocket costs for patients and a decline in access to physicians," says Paul B. Ginsburg, PhD, president of HSC.

Before we panic, however, Ann S. O'Malley, MD, coauthor of the report, cautions that "despite media reports about doctors dropping out of insurance networks because of payment and administrative hassles, the vast majority of physicians continue to contract with managed care plans."

Other key findings from the report indicate that physicians in solo or two-physician practices are less likely to contract with managed care plans than are larger practices or institution-based practices, perhaps reflecting their higher costs and difficulties with administrative oversight. In addition, physicians in practice for more than 20 years are less likely to contract with plans than those in practice for no more than 10 years. This suggests that experienced physicians may have developed the patient base and reputation that allows them to practice without managed care contracts. About 23 percent of physicians who are in solo or two-physician practices and who are older than 60 (7 percent of all physicians) do not contract with managed care.

Physician contracting and managed care revenue

Physicians with no managed care contracts

Average number of MC contracts for physicians with more than one MC contract

Physicians with no managed care revenue

Percent revenue from managed care for physicians with >= 1% managed care revenue (mean)

*Change from 2000–2001 is statistically significant at p < .001

Source: Community Tracking Study Physician Survey

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.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

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?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

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.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

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.