There’s a lack of competition among health insurers, according to the American Medical Association. A new survey by the physician group says that a vast majority of commercial health insurance markets are dominated by one or two health insurers and that 99 percent of health insurance markets are highly concentrated, according to results published in Competition in Health Insurance: A Comprehensive Study of U.S. Markets.… Roughly 3.4 million people visited emergency departments looking for relief from an aching back, according to the Agency for Healthcare Research and Quality’s “News and Numbers” report. That’s an average of 9,400 per day. The report also says that adults ages 18 to 44 were most likely to require emergency department care (1,569 visits per 100,000), but people ages 65 to 84 were the least likely to visit an emergency department for the condition. However, that younger population was less likely to need hospitalization, while the senior population had the highest rates of hospitalization (130 hospital stays per 100,000 versus 607 per 100,000 people).… The Medicare Payment Advisory Commission recommended that Congress update physician payments in 2012 by 1 percent. The commission also voted unanimously to recommend a 1 percent update to both hospital inpatient and outpatient services. The recommendations will be included in the commission’s March 2011 Report to Congress on Medicare Payment Policy.
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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.