UnitedHealthcare seems to be jumping onto the accountable care bandwagon in a big way. The insurer says it plans to increase payment to providers through contracts linked to quality and cost-efficiency to $50 billion by 2017. “Our unparalleled experience with accountable care models — and there are many — demonstrates that they can work better for everyone in health care, from patients to payers to care providers,” says Austin Pittman, the president of UnitedHealthcare Networks.... Meanwhile, WellPoint must pay a fine of $1.7 million for exposing the personal information of over 600,000 beneficiaries because an online application database could be hacked. WellPoint informed those who may have been affected and beefed up online security. The hacked data includes names, birthdates, addresses, and Social Security numbers.... You can knock yourself silly exercising but that doesn’t necessarily mean you’ll lose weight, according to researchers at the University of Washington. Even though Americans are exercising more, the obesity epidemic continues to grow. We still consume more calories than we burn off, says the study’s senior author Ali Mokdad, PhD, at the university’s Institute for Health Metrics and Evaluation.... Americans are living longer but not necessarily more happy lives compared to other countries. A study of health statistics in 34 countries published recently in the Journal of the American Medical Association shows that rates of substance abuse, psychiatric disorders, and muscle and joint pain all increased in the United States in the last 20 years. Life expectancy in the U.S. increased from 75.2 in 1990 to 78.2 in 2010.
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.