As Congress considers various proposals to reform the health care system, America’s Health Insurance Plans has issued a report that highlights measurable results that private health insurance pay-for-performance programs have achieved. The report, Innovations in Recognizing and Rewarding Quality, describes models that have reduced costs, enhanced quality, and improved patient satisfaction.... Use of e-prescribing — electronic prescription benefit, history, and routing — jumped 61 percent in the first quarter of 2009, compared to the past two years according to Surescripts, an electronic prescribing network. That amounts to more than 134 million e-prescribing messages being exchanged among providers, payers, and pharmacies. Imagine the bill from your mobile carrier if these were text messages.... More than half of primary care physicians who reported problems getting mental health services for their patients cited lack of insurance coverage, inadequate coverage, health plan barriers, and shortages of mental health providers as “very important” reasons their patients couldn’t get care. These findings appear in the article “Beyond Parity: Primary Care Physicians’ Perspectives on Access to Mental Health Care,” in the April issue of Health Affairs.
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.