The Cleveland Clinic has joined with the Internet giant Google to test a secure exchange of patient medical record data involving prescriptions, conditions, and allergies. The exchange will occur between the patient’s electronic personal health record housed at the clinic and a secure Google profile that could be accessed, for instance, in a doctor’s office or a hospital. The ultimate goal of this experiment, in which the patient controls the flow of information, is to give patients the ability to interact with multiple physicians, health care providers, and pharmacies.…. A regulation to establish patient safety organizations (PSOs) has been promoted by the U.S. Department of Health and Human Services. PSOs are private entities that would collect and analyze patient safety events reported by health care providers. Under the proposal, a hospital could describe in detail how the wrong leg happened to be amputated without fear of being hit with a lawsuit (at least as a result of this exchange of information). Under the proposal, PSOs can collect, aggregate, and analyze data, and provide feedback to help providers and health care organizations improve health care quality.…. America’s Health Insurance Plans is pushing a proposal with state insurance regulators that would give consumers the right to appeal policy rescissions based on an insurer finding out that the patient had a pre-existing condition that had not been disclosed during initial enrollment. The proposal would call for individual states to use independent panels of health care professionals and lawyers to review such cancellations. Details of how the process would function hadn’t been finalized, the group said at press time, so stay tuned. — Tony Berberabe
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.