In the first half of 2010, five of the largest for-profit managed care companies — WellPoint, UnitedHealth, Aetna, Humana, and Cigna — reported high profits, according to a KPMG report. The net income of these companies collectively increased 20.2 percent in the first half of 2010 to $6.05 billion, compared with the same period in 2009.... Almost one third of uninsured people eligible to receive subsidies to buy insurance through state-based exchanges have had no recent health problems, access to medical care, or paying medical bills, according to a national study released by the Center for Studying Health System Change. Enrolling these uninsured people is likely to be challenging but essential to avoiding adverse selection in the exchanges, according to the study. Otherwise, health insurance costs in the exchanges could be higher than expected. Many of these healthy and low-cost uninsured people view themselves as risk-averse, the study found, which could motivate them to gain coverage in the absence of health or access problems..... CMS reports that 5 of the 10 physician groups that are participating in the five-year Medicare program for quality will receive bonus payments this, the fourth year. The bonuses total $31.7 billion and are based on how much physician groups save Medicare and how well doctors perform on measures of quality.
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.