Aetna is unveiling something it calls the Medicare Open Plan, targeted for employers who want to offer retirees age 65 or over a fee-for-service Medicare Advantage plan. If CMS approves, Aetna hopes to launch the plan in January 2007.... A consumer-directed effort by Tufts Health Plan hasn't planned out the way management had hoped. Tufts is canceling its three-year joint venture with Destiny Health, a CDHP provider, because of a failure to meet enrollment goals. The plan, called Liberty, gained about 10,000 members since its launch in September 2003.... Medicaid managed care is making "outroads" in Colorado. Citing low payment rates, Colorado Access, the only private Medicaid HMO left in the state, plans to end its contract with Colorado in August. It has been a bumpy road for the program all along. In 2004, four HMOs sued the state for alleging underpaying. Colorado paid millions to settle and those four HMOs left the program. Now Colorado Access is leaving. Its CEO, Don Hall, says there just isn't enough money to be made.... People with unhealthy lifestyles should pay more for insurance, according a poll taken by the Wall Street Journal and Harris Interactive. An online survey of 2,325 adults in the United States found that 53 percent of respondents are fine with the idea of charging smokers and overweight people more. In 2003, 37 percent liked the idea when asked the same question. Could be a societal switch, something to think about on your cigarette break — way, way off in the corner of the parking lot there.
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.