About 1 in 6 Americans report paying more than 10 percent of their total family income for health insurance premiums, says the latest report from the Agency for Healthcare Research and Quality. Of those with employer-sponsored insurance, 16 percent spend 10 percent or more of their income on premiums and out-of-pocket expenses. Of those with public insurance, 16 percent spend 10 percent or more of their income on out-of-pocket expenses (and 84 percent do not).… Advising adult patients to get vaccinated for the flu, especially during the 2009–2010 pandemic, would seem to make a lot of sense. But a study in Preventive Medicine suggests that 64 percent of adults did not receive any provider-issued influenza vaccination recommendation. Adults who were advised to get vaccinated were 14.1 to 32.1 percentage points more likely to get vaccinated than adults who did not receive a recommendation…. A merger between Medco and Sanofi will help the French drug manufacturer navigate the American payer and regulatory landscape. Sanofi’s research and development will benefit from the merger, gaining a perspective on the views of health insurers and governments that are seeking evidence of a drug’s demonstrated benefits before paying for it. Sanofi will benefit from Medco’s voluminous claims data, which it collects by providing pharmacy benefits to millions. Medco will be a consultant to the drugmaker on comparative studies for both experimental and approved drugs.
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.