The National Institutes of Health stopped a cardiovascular clinical trial early for lack of benefit. The trial was halted after it was determined that a combination treatment of a statin with Niaspan didn’t reduce the rate of heart attacks, strokes, heart-related hospitalizations, or the number of procedures needed to improve blood flow in the arteries of the heart and brain.... Primary care providers anywhere can be trained with videoconference technology to manage complex chronic conditions formerly outside their expertise, thus expanding their ability to treat very sick patients. These findings, published in the New England Journal of Medicine, evaluate data from Project ECHO (Extension for Community Healthcare Outcomes). Sanjeev Arora, MD, the hepatologist who created Project ECHO, says, “This model empowers primary care clinicians to provide high-quality specialty care locally, and holds promise for dramatically changing clinical practice and medical education nationally.”… Four of the seven largest health plans, in terms of enrollment, had greater profits in 2010 than in 2009, according to a recent “Healthcare Business Strategy” report from Mark Farrah Associates, a market data aggregator.
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.