Members of Blue Cross and Blue Shield companies and privately-held health plans tend to rate their overall service experience notably higher than enrollees of non-Blue plans owned by publicly-traded companies, says new study by J.D. Power and Associates. The study asked 10,522 members of large commercial health plans to rank the performance of 49 large health plan companies in the Northeast, South, Midwest, and West. Leading the regions were Harvard Pilgrim Health Care in the Northeast; BlueCross and BlueShield of Florida in the South; BlueCross and BlueShield of Minnesota in the Midwest; and Premera Blue Cross in the West.... More employers are offering consumer-directed health plans (CDHPs), according to a survey by Watson Wyatt Worldwide and the National Business Group on Health. Employers offering CDHPs increased from 33 percent to 38 percent in the last year. Forty percent of employers now offer or plan to offer a health savings account, and 26 percent offer or plan to offer a health reimbursement account.... Using low-dose computed tomography (CT) to screen smokers for lung cancer may increase the rate of lung cancer diagnosis and treatment, but may not reduce the risk of advanced lung cancer or death. Researchers at Memorial Sloan-Kettering Cancer Center conducted a longitudinal analysis of 3,246 asymptomatic current or former smokers who were screened for lung cancer beginning in 1998. They concluded that until more definitive data are available, asymptomatic individuals should not be screened outside of clinical research studies that have a reasonable likelihood of further clarifying the potential benefits and risks.
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.