Eight managed care plans have been recognized by the National Committee for Quality Assurance for their innovative programs aimed at improving health care for African Americans, Hispanics, Asians, and other ethnic groups. The winners of the “Recognizing Innovation in Multicultural Health Care Awards” were Aetna, Highmark, Keystone Mercy Health Plan, Molina Healthcare of Michigan, UnitedHealthcare of New York, UnitedHealthcare Latino Health Solutions, Virginia Premier Health Plan, and WellPoint. . . . Fifteen pharmacy benefit managers have agreed to do business in a fully transparent manner, according to the HR Policy Association. To be considered, PBMs have to agree to meet the HR Policy Association Pharmaceutical Coalition’s standards, which provide employers with the most rigorous level of drug purchasing transparency available. . . . Medicare’s Physician Quality Reporting Initiative got low marks from medical practice leaders, according to the Medical Group Management Association (MGMA). The group’s members voiced their frustration with the initiative, citing the lack of data available for improving patient outcomes, the administrative burden of participating, the difficulty accessing and downloading the 2007 feedback reports, and delays in receiving the results, sometimes as long as 18 months after initial submission of data.
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.