According to a Milliman & Robertson study, 55 percent of all Medicare inpatient hospital days were potentially unnecessary in 1996. Basing its calculations on its own length-of-stay and admission guidelines, M&R concluded that the average LOS could have been reduced from 6.4 to 4.1 days, and that 43 percent of admissions were unneeded... An independent auditor for the American Association of Health Plans says a third of its members are not in full compliance with its Code of Conduct, formerly the Putting Patients First initiative. AAHP offers that 95 percent comply with six of the code's seven principles, and that all promise full compliance within a year. When it launched Putting Patients First, AAHP promised to kick out members that did not adhere to its standards.
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.