Twenty million young adults between ages 19 and 29 were uninsured at some time during the past year, according to a recent survey by the Commonwealth Fund. Eighty-eight percent of young adults think it is important that Congress and the president pass health reform legislation that would assure affordable insurance for all and improve health care.... Value-based benefit designs (VBBDs) are gaining more traction among health plans. A recent HealthLeaders-InterStudy report says that three major insurers — Blue Cross Blue Shield of Massachusetts, Health Alliance, and Blue Shield of California —are rolling out VBBD packages to the fully insured market. VBBD reduces cost barriers to medications deemed most effective in controlling chronic diseases to drive patient compliance with treatment.... The National Committee for Quality Assurance (NCQA) issued changes to its disease management accreditation and certification requirements, adding voluntary performance reporting for five chronic conditions. With the new changes, NCQA becomes the first DM accreditation organization to use performance measures to assess the effect of programs on care for people with asthma, diabetes, chronic obstructive pulmonary disease, heart failure, and ischemic vascular disease. Additional changes to the standards focus on care coordination, data integration, quality improvement, and transparency in reporting.
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.