Private insurers paid $272 billion in hospital charges in 2005, according to “National Hospital Bill: Growth Trends and 2005 Update on the Most Expensive Conditions by Payer,” a report issued by the Agency for Healthcare Research and Quality. The total 2005 hospital bill, which is adjusted for inflation, was $874 billion and accounted for 39 million hospital stays. The average yearly rate of increase in the national hospital bill over the last several years was 4.5 percent. At this rate, researchers estimate that the annual national hospital bill may reach $1 trillion in 2008.... Health Level Seven, America’s Health Insurance Plans, and the Blue Cross & Blue Shield Association announced that they have agreed to create a collaborative process to maintain portability standards for personal health records. The group contends that the more stakeholders involved in developing and approving portability standards, the more easily plan members will be able to move their personal health data when coverage changes.... More than half (53 percent) of health care payers surveyed in “Financial Transparency: Health Care Payer Strategies and Execution, 2007–2009” planned no additional investment in transparency initiatives in 2008. Instead, health care payers will assess the effectiveness and return on current transparency initiatives to identify best-practice industry models. Key initiatives include creating electronic access to information; improving data and information processes; consolidating data sets to produce accurate, reliable data sources; and adopting standards.
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.