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.
The trade association has been hit by defections, deficits, and staff departures. Its new CEO, Marilyn Tavenner, vows to get the get things right again and focus on what’s even more important: helping the insurance industry adjust to changes brought about by the ACA and a shifting marketplace.
The former CMS chief knows how to fix a mess. Remember the launch of Healthcare.gov? Short term: AHIP’s new CEO wants to coaxed UnitedHealth Group and Aetna back into the lobbying organization. Long term: Health plans should be major players in efforts to reform the delivery system.
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.
Fla. Safety Net Hospital Alliance
Free-market advocates question state say-so over major hospital projects. They have a strange bedfellow.
ACOs are providers while MA plans are insurers. Still, CMS’s Next Generation ACOs have a familiar look and feel.
Richard Stefanacci, DO
UnitedHealthcare, Aetna, and Humana all lose money, but Cigna’s CFO says that’s just the price for getting started in a new market.
Ethan Basch, MD
Cancer patients talking to doctors doesn’t work very well: Half of all symptoms go unreported. Computerized systems and email prompts may do a better job.
Alirocumab, evolocumab, and sebelipase alfa further fuel the discussion about just how to go about covering exciting, but costly, high-priced agents.
Percent of U.S. health care spending by 7 core health consumer segments