Adding pharmacists to the primary care team right in doctors’ offices might help patients with chronic diseases manage their risks better, a new University of Alberta study suggests. The blood pressure of patients with type 2 diabetes dropped significantly when pharmacists were included in the on-site clinical examination and consulting process. Nearly 54 percent of patients who had received advice from a pharmacist were more likely to reach blood pressure treatment targets.... Urologists who own their practices ordered more imaging than urologists who receive a salary, according to data from the National Ambulatory Medicare Care Survey. More than 1 in 5 urology visits resulted in imaging, with nearly twice as many self-employed urologists ordering imaging tests than urologists employed by a health care institution (24.2 percent vs. 13.2 percent). Findings are in the December issue of the Journal of Urology.... After three months in operation, enrollment in high-risk pools has been anemic, with just 8,011 enrolled nationwide. The Patient Protection and Affordable Care Act established the Pre-Existing Condition Insurance Plan for people with pre-existing conditions until 2014, when private insurers are required to accept all applicants. Richard Popper, director of insurance programs at the Department of Health and Human Services, says, “It takes a while for advocates and stakeholders to realize there’s this new plan.” Meanwhile, come January 1, HHS will give consumers choices of plans with different costs and deductibles, hoping to draw more interest and enrollees.
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.