Private insurers who participate in Medicare Advantage have received guidelines from the Centers for Medicare and Medicaid Services that they must meet if they want to bid on Medicare insurance business this year. The guidelines protect sicker beneficiaries from discriminatory out-of-pocket charges for the health care services they need. .... Employers remain confident that employer-based health benefits will still exist 10 years from now, but their level of confidence has slipped from last year because of concern about the economy and uncertainty about potential reform, according to a report by Watson Wyatt. A survey of 489 large employers shows that 62 percent are confident that they will offer health care benefits 10 years from now, but that is down from 73 percent last year....The nation’s health insurers may be embracing the use of personal health records (PHRs), but it remains to be seen whether patients and providers will do likewise, according to a recent study conducted by the Center for Studying Health System Change (HSC). A PHR is a centralized place for people to electronically store and organize their personal health information, separate from electronic or paper medical records maintained by their providers. The HSC researchers interviewed 35 health insurance executives. Joy M. Grossman, PhD, a senior researcher at HSC and coauthor of the study, concluded that “to date, most insurers haven’t actively marketed PHRs to enrollees and physicians, and patient acceptance and physician awareness of insurer-sponsored PHRs appears to be low.”
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.