Payments to hospitals that adhere to “meaningful use” standards for implementing health information technology seem to be working. Medicare and Medicaid offer incentive payments to hospitals that use health IT under the American Recovery and Reinvestment Act of 2009, aka “the stimulus.” The percentage of U.S. hospitals adopting health IT rose from 16 percent to 35 percent from 2009 to 2011, according to a survey by the American Hospital Association.... Knee replacement surgeries have more than doubled in the last 10 years, according to a study by the U.S. National Institutes of Health’s National Institute of Arthritis and Musculoskeletal and Skin Diseases. Of people 50 and older, 4.7 percent have had knee replacement.... Medicare Advantage beneficiaries with diabetes see their doctors more often and the emergency room less than diabetes patients in the Medicare fee-for-service program, according to a report in Health Affairs. “Medicare Advantage Chronic Special Needs Plans Boosted Primary Care, Reduced Hospital Use Among Diabetes Patients” shows that health plans “have played a leadership role in bringing programs to the delivery system that are helping patients get appropriate follow-up care and avoid preventable hospital readmissions and emergency room visits,” says Karen Ignagni, president and CEO of America’s Health Insurance Plans, which helped conduct the study.
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.