Purchasers are increasingly requiring health plans to focus on the quality of health care delivered to consumers, according to the National Business Coalition, which says that more health plans are reducing barriers to essential treatments. For example, 27 percent of plans are waiving copayments for diabetes drugs and 33 percent have reduced copayments… Low Medicare and Medicaid payments to hospitals and physicians lead to significantly higher insurance costs for consumers and employers, according to a study by Milliman. The study found that annual health care spending for an average family of four is $1,788 higher than it would be if Medicare, Medicaid, and private insurers paid hospitals and physicians at similar rates. Government payers tend to underpay hospitals and physicians. This creates a payment gap that privately insured employers and consumers must close through cost shifting, which is the difference between actual payment rates and average payment rates… Nineteen percent of employees are willing to pay higher premiums in order to keep deductibles and copayments lower and more predictable, says a survey from Watson Wyatt. Last year, though, 38 percent chose the higher premiums. Some workers are taking actions that could lead to higher costs in the future. For example, 17 percent reported that they avoided a recommended doctor’s visit this year to save costs. Similarly, 17 percent did not fill a prescription or skipped doses of prescribed medications, an increase from 13 percent in 2007.
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.