Initial bids are in and it appears that premium growth will be slowing even more in 2007, according to a report by Hewitt Associates. On average, HMOs are proposing to raise premiums 11.7 percent next year. The companies last year initially asked for 12.4 percent increases. Some experts think that the rate increases might wind up in the 7 percent to 8 percent range, which will make 2007 the fourth consecutive year premiums rose more slowly than the year before.... Certification guidelines for health care information technology are in the works. The guidelines are expected to be developed by a coalition of companies called the Continua Health Alliance, which includes IBM, Cisco Systems, Kaiser Permanente, and Phillips Electronics. Two goals will be that the technology meet interoperability standards and that it become easier for consumers to get reimbursed by insurers for using monitoring technology in the home, according to the Wall Street Journal.... New technology doesn't come cheap. Spending on specialty drugs rose 17.5 percent last year, according to a study by Express Scripts. The PBM says that spending on specialty drugs will reach $90 billion by 2009.... Some interesting legislation is under consideration that would increase the ability of health insurers to obtain a share of money awarded to employees in personal injury lawsuits. Under the plan, insurers would be awarded a portion of settlement to recover money lost in providing medical care. Currently, state and federal law limit insurers' ability to do so. Patient advocates worry that there won't be much of the settlement left for the consumer after an insurer gets what it considers its share. The proposal is in a House-Senate conference committee.
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.