UnitedHealthcare and WellPoint were singled out for praise by Health and Human Services Secretary Kathleen Sebelius. By the fall, under the Patient Protection and Affordable Care Act, children under the age of 26 will have the option of staying on their parents’ plans. Sebelius praised the two companies for not waiting until then to begin providing such coverage. This praise comes at a good time for WellPoint, which has recently been accused of recission by enrollees who had been diagnosed with breast cancer.... Comparative effectiveness research, already given a $1.1 billion boost by the American Recovery and Reinvestment Act of 2009 — the stimulus — will get an added infusion of $3 billion thanks to the Patient Protection and Affordable Care Act. Bloomberg BusinessWeek reports that interest in such research has spurred UnitedHealthcare to acquire QualityMetric, a company that “measures how patients rate the effectiveness of care.”
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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.