The Disease Management Association of America (which now calls itself DMAA: The Care Continuum Alliance) has issued the second volume of the "Outcomes Guidelines Report." The original report sought to develop the correct way to calculate the return on investment of disease management programs. Volume 2 updates the previous version by adding new clinical measures, building on measuring financial outcomes in disease management and population health programs, providing a wellness program model, and focusing more on small populations. In particular, key clinical outcomes measures were developed jointly by DMAA and the National Committee for Quality Assurance (NCQA).
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.