Consumer directed health plans (CDHPs) deliver modestly better cost savings than non-CDHPs, according to the “Consumer-Driven Impact Study” by Milliman. When adjustments are made for typical risk and benefit factors, CDHPs produce 1.5 percent in savings beyond traditional plans. . . . WellPoint announced that it is launching the first real-time drug surveillance system that will monitor the insurer’s 35-million-member database and identify increases in health problems among members taking a given drug, indicating a potential serious adverse event (SAE). It is expected that the company’s Safety Sentinel System will also make it possible to examine whether particular combinations of treatments could cause serious medical problems, especially in patients with certain diseases or health conditions. . . . Small businesses feel the pinch of providing health insurance to employees more than their large counterparts do, according a Rand study, “Economic Burden of Health Insurance Increasing for Small Employers Providing Health Insurance.” The cost of insurance for these small businesses rose nearly 30 percent from 2000 to 2005, significantly more than the hikes experienced by medium and large businesses during the same time.
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.