Paying hospitals extra money does not appear to improve the way they treat heart attack patients, or how well those patients do. But giving hospitals the information that they need to improve heart attack care does help. Researchers at the Duke University Clinical Research Institute found no evidence that financial incentives were associated with improved outcomes, nor that hospitals had shifted their focus from other areas in order to concentrate on the areas being evaluated for possible increased payments.... In the coming months, patients at Mount Sinai Medical Center and nine other New York City hospitals will receive a wallet-size "smart card" that will reduce paperwork and protect against medical errors. Each card will have a picture of the patient and an embedded chip that will store important medical information. Patients will be able to authorize providers to access their medical history, reducing waiting time and improving the flow of information among providers..... CMS and health plans are collaborating on a pilot program to encourage Medicare beneficiaries to optimize their health using Internet-based tools. The program will enable beneficiaries to access and use personal health records (PHRs) provided by either Medicare Advantage or Medicare Part D plans through «www.mymedicare.gov». PHRs enable individual patients and their designated caregivers to view and manage health information and play a greater role in their own health care. PHRs are different from electronic medical records, which providers use to store and manage detailed clinical information. The five insurers participating are HIP USA, Humana, Kaiser Permanente, and the University of Pittsburgh Medical Center.
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.