In a study of seven industrialized countries, the United States came in last overall in health system performance, despite having the most expensive health care system. A new Commonwealth Fund report looks at measures of health system performance in five key areas: quality, efficiency, access to care, equity, and the ability to lead long, healthy, productive lives. The other countries ahead of us are Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom. The report says the United States does not get good value for its health care dollars, ranking last despite spending $7,290 per capita on health care in 2007, compared with $3,837 in the Netherlands, which ranked first overall. Commonwealth Fund president and lead author Karen Davis says the findings were “disappointing but not surprising,” but she thinks with the passage of the Patient Protection and Affordable Care Act the U.S. can begin “strengthening primary care and investing in health information technology and quality improvement”.... “One in five medical claims is processed by insurers with errors,” says Nancy H. Nielson, MD, immediate past president of the American Medical Association (AMA). This is echoed by findings from that group’s “National Health Insurer Report Card.” According to the AMA’s findings, the health industry as a whole has about an 80 percent accuracy rate for processing and paying claims. Of the seven insurers reviewed, Coventry Health Care came out on top, with a national accuracy rating of 88.4 percent. Anthem Blue Cross Blue Shield came in last at 74 percent. The seven insurers were Aetna, Anthem BCBS, Cigna, Coventry, Health Care Services Corp., and UnitedHealth Group.... The nation’s employers can expect medical costs to increase by 9 percent in 2011, a decrease of half a percentage point from the 2010 growth rate, according to a recent report issued by the PricewaterhouseCoopers Health Research Institute. For the first time, a majority of the American workforce will have a health insurance deductible of $400 or more, as more employers return to indemnity-style cost-sharing by raising out-of-pocket limits, replacing copayments with coinsurance, and adding high-deductible health plans.
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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.