Health insurance for all is essential, but not enough, says the Commonwealth Fund. In the report A High Performance Health System for the United States: An Ambitious Agenda for the Next President, it outlines strategies to contain costs and organize the health care delivery system…. An Ohio House bill may require fully-insured health plans to cover treatment and diagnosis for autism. Many health plans cover the diagnosis, but not the treatment. The proposed bill is modeled on a three-month old health parity law that requires health insurance providers to cover certain psychological conditions…. Combining one well known comparatively low cost synthetic drug with 1 of 6 biologic medications often works best to reduce joint swelling or tenderness, according to a new report funded by the Agency for Healthcare Research and Quality (AHRQ). The report titled, “Comparative Effectiveness of Drug Therapy for Rheumatoid Arthritis and Psoriatic Arthritis in Adults,” concludes that combining methotrexate, a synthetic disease-modifying antirheumatic drug (DMARD), with one of the biologic DMARDs works better than using methotrexate or a biologic DMARD alone. The report also found that methotrexate works as effectively as the biologic DMARDs adalimumab and etanercept for patients who have early-stage rheumatoid arthritis. Adalimumab and etanercept, however, show better short-term results as measured by X-rays of joints.
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.