Six California companies have begun paying physicians $20 for e-mail "visits" with patients.... More than half of HMO patients surveyed in an Archives of Internal Medicine study worry that capitation compromises quality of care.... Aetna admits that poor record keeping and incommunicative computer systems led it to pay millions in benefits in recent years to people whose coverage had expired.... A federal judge ordered United Healthcare to refund $4 million to members overcharged when their coinsurance rates were not adjusted to compensate for lower physician fees.... Johns Hopkins University will begin a program to verify and evaluate reported outcomes, thanks to a $6 million commitment from American Healthways, the disease management company.... Use of herbal supplements increased 350 percent from 1996 to 1999, according to a Kaiser Permanente survey .... Obesity correlates more strongly with chronic illness than do alcoholism, smoking, or economic status, according to a study in Public Health.
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.