Fifty-seven percent of employers with 500 or more workers are providing wellness programs to their workers. This is up from 49 percent in 2006. The number of smaller employers that offer programs has remained steady the last two years at 16 percent, according to MetLife’s Employee Benefits Trends Study… Hawaii has dropped the only state universal child health care program in the country, just seven months after it was launched. Gov. Linda Lingle’s administration cited budget shortfalls and the availability of other health care options. An administrator at the state’s Department of Human Services said that families were dropping private health coverage so their children could be eligible for the free care. “I don’t believe that was the intent of the plan,” said Kenny Fink, MD… PharmMD is teaming up with HealthSpring to provide medication therapy management services to more than 265,000 of HealthSpring’s members. MTM attempts to prevent medication error, misuse, underuse, and abuse by ensuring that individual patients receive the most appropriate drugs possible. MTM is intended to ferret out duplicate medications and prevent harmful drug interactions. PharmMD is providing the managed care organization with information technology to help monitor pharmacy utilization records. The plan’s pharmacists will be able to better watch for potential drug interactions and for opportunities to optimize a patient’s drug regimens.
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.