Optum, a subsidiary of UnitedHealth Group, last month launched a think tank called the Optum Institute, whose mission is to focus “on providing analysis and insight on accountable care and the rapidly changing health care landscape,” according to the company. At the same time, Optum published a survey called “Sustainable Health Communities — a Manifesto for Improvement.” Quite a big undertaking that you can see for yourself at http://bit.ly/rWCjdQ.... Over 52 percent of office-based doctors now use electronic prescribing, according to SureScripts, the operator of an e-prescription network that connects doctors’ offices to pharmacies. SureScripts adds that 94 percent of retail pharmacies now accept electronic prescriptions.... The standard of care for type 1 diabetes comes up short when compared with treatment that includes at least three injections of insulin a day or use of an insulin pump, according to a study that followed a group of diabetic patients since the 1980s. The study is by Ian de Boer, MD, a kidney specialist at the University of Washington in Seattle. More than 1,400 diabetic patients were followed and those receiving intense treatment were only half as likely to have developed kidney disease than those given the standard treatment, which does not focus as much on getting patients to near-normal blood sugar levels.
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.