This limited or tiered network benefit package lets the health plan hold the insurance license and perform its traditional insurer functions while the hospital system acts as the leading in-network provider. The plan gains market share, while the provider makes more money. Sounds like a win-win.
Aside from the Affordable Care Act, it’s the biggest event in health care, says the savvy consultant. “…[I]f the hospital has enough market power, the parties come to an agreement but from the plan’s perspective it is certainly not a happy agreement.”
Ever hear of incidentalomas? That’s the word coined by radiologists for overtesting leading to overtreatment, one of the topics touched on in the book, Cracking Health Costs: How To Cut Your Company’s Health Costs and Provide Employees Better Care, by Tom Emerick and Al Lewis. Here’s an excerpt.
There might not be an “I” in team, but there’s a “Me.” All the emphasis these days on collaboration might not undo years of training and practice methods. Physicians are taught to be independent. If lower-level providers speak up, will doctors really be willing to listen?
Quantity-limit programs seem like a good idea. Split the treatment cycle into two shipments, and make sure the patient is adherent before sending the second one. But a closer look at the data reveal that there is no real overwhelming financial — or even clinical — justification for such a move.
Often a decade or more separates the discovery of a better practice method, and its implementation among providers. Health plans face the challenge of how best to disseminate information, guidance, and performance data to doctors who are already overwhelmed. New tools might help.
Regular assessment of patients’ responses to therapy using BRC-ABL1 levels can improve long-term outcomes for chronic myeloid leukemia, but this approach is not routine in clinical practice. Without such monitoring there’s a chance to overlook patients who might benefit from a change in treatment plans.
Mike Pellini, MD
With limited peer-reviewed literature, health plans take an evaluative approach to tumor profile testing
At issue is how much large provider systems can charge for services after they’ve acquired physician practices
Robert Royce, PhD
The country’s catastrophic economic situation shrinks coverage, closes hospitals, and cuts physicians’ salaries — and that might be just the beginning
The insurer hopes to give businesses of between 50 and 400 employees more flexibility under defined contribution
This new treatment for nephritic cystinosis costs a quarter million annually, whereas the original formulation comes in at $8,000