Colorectal cancer screening for white, black, and Asian Americans age 50 and over has improved says the Agency for Healthcare Research and Quality. The same can’t be said for Hispanics, whose screening rates barely improved, or for American Indians, whose screening rates fell.... Members in integrated health systems report higher rates of satisfaction than members in plans in which the provider and payer are not part of the same organization, according to a recent survey conducted by J.D. Power and Associates titled 2011 U.S. Member Health Insurance Plan Study. These plans, such as Health Alliance Plan and Kaiser Foundation Health Plan, average a satisfaction score of 741 (1,000-point scale) compared with nonintegrated plans, which average 69.... Approximately 24 million people will purchase health insurance coverage through the American Health Benefits Exchanges by 2019, according to the Congressional Budget Office. The AHB Exchanges were created under the Health Insurance Exchange program by the Affordable Care Act. The exchanges will be rolled out in all states by Jan. 1, 2014.
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.