Federal regulators want insurers who participate in exchanges to offer benefits that include a wider range of providers. CMS is considering a proposal that would require insurers to submit a full list of their providers as a condition for being approved to sell plans on the exchanges. The move comes as consumers complain about lack of access to some specialists and medical centers. The industry group America’s Health Insurance Plans counters that narrower networks are one way to keep down costs.... People seeking help for mental health disorders have a tough time as it is, and it may get even tougher. Many places in the country do not have enough mental health providers, and many such providers do not accept private insurance. Meanwhile, the Affordable Care Act will allow about 7 million additional people to try to get mental health services.... Kidney damage is always a risk of surgery because of the possibility of the organs being deprived of blood during the procedures. Patients suffering kidney damage are much more at risk of developing heart problems, according to a study in the Journal of the American Society of Nephrology. Researchers compared data from patients who needed dialysis to recover from injuries with data from those who did not.
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.