A recent study identifies a new way to classify humans — by the type of bacteria found in the human gut. German researchers found that the bacteria in the human gut, called enterotypes, fall into distinct types. And just as the discovery of different blood types helps physicians practice medicine, the discovery of different enterotypes may some day help physicians tailor diets or drug prescriptions to suit the distinct enterotypes.... Hospital admissions of uninsured patients jumped 21 percent from 2003 to 2008, according to the Agency for Healthcare Research and Quality. Hospital stays for all patients rose only 4 percent.... The Academy of Managed Care Pharmacy is searching for a new CEO after an announcement that the group’s long-time leader, Judith Cahill, will be leaving.
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.