The burden of diabetes just got bigger, according to epidemiologists at the National Institutes of Health and the Centers for Disease Control and Prevention. Nearly 13 percent of adults age 20 and older have diabetes, but 40 percent of them have not been diagnosed. An additional 30 percent of adults have pre-diabetes, a condition marked by elevated blood sugar that is not yet in the diabetic range. Researchers used newly available data from an oral glucose tolerance test, which gives more information about blood glucose abnormalities than the traditional fasting blood glucose test. Findings are reported in the February issue of Diabetes Care… The California Supreme Court has barred the practice of balance billing that hospitals and emergency department physicians use to charge patients directly when their HMOs refuse to pay. The practice occurs when insured people seek emergency care from out-of-network physicians and hospitals… New data-reporting guidelines became effective on Jan. 1. The Centers for Medicare and Medicaid Services has issued guidance documents for group health plans and their insurers and third-party administrators (TPAs). The guidelines should facilitate coordination of benefits with Medicare. Insurers, TPAs, and plan administrators are required to collect data, including Social Security numbers or health insurance claim numbers, and file these data electronically with Medicare.
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.