The United Kingdom’s National Health Service came under fire recently when it chose one vaccine to prevent cervical cancer over a rival. The vaccine program, which will protect young girls who might develop cervical cancer later in life, will dispense Cervarix, a vaccine that offers immunity to human papilloma virus (HPV) types 16 and 18, which are responsible for 70 percent of cases of cervical cancer. However, some experts say the agency should have chosen Gardasil, which besides protecting girls from HPV type 16 and 18, also provides protection against two other strains that can cause genital warts. A spokesperson for the NHS says, “The contract has been awarded for the vaccine that scored best overall against a number of pre-agreed criteria and offers best overall value to the NHS.”. . . Among national payers, Aetna pays providers the fastest, according to a survey conducted by Athenahealth. The survey used claims from more than 12,000 medical providers. It ranks health insurers according to specific measures of financial and administrative performance and on medical policy complexity. The five with the fastest remittance times were Aetna, Humana, Cigna, Medicare Part B, and UnitedHealth, in that order… Consumer Reports is launching a health ratings service that will add ratings for hospitals and health care providers to its current ranking of health-related products, treatment options, natural medications, and drugs. The first undertaking is a Web tool created in conjunction with the Dartmouth Atlas Project (see our Plan Watch column on page 53) that will allow consumers to compare treatment approaches among hospitals for nine chronic conditions. The rankings can be found at http://www.consumerreports.org/ health/doctors-and-hospitals/ hospital-home.htm.
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.