The Department of Health and Human Services extended the comment period for proposed privacy regulations to Feb. 17, giving groups time to determine whether unintended consequences would prevent coordinated care.... Only 5.9 percent of HMO members rate trust in their health plans "very high" in a National Research Corp. survey. If that seems low, it's better than the 3.8 and 3.6 percent marks achieved by PPOs and fee-for-service plans, respectively.... Visits to physicians for diabetes rose 10 percent from 1998 to 1999, according to a Scott-Levin audit. That coincided with a 13-percent boost in prescriptions for oral diabetic medications.... Three mega-employers, including IBM, turned to a new vehicle for purchasing health care last year: Internet auctions, orchestrated by Hewitt Associates, the benefits consultant. Fifty plans bid against each other online for the business. The buyers wound up with premiums 2 to 8 percent lower this year than in 1999.
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.