Carolyn M. Clancy, MD, has been appointed director of the Agency for Healthcare Research and Quality. Clancy has served as acting director since the death of John M. Eisenberg, MD, in March 2002. Prior to that, she'd been director of AHRO's Center for Outcomes and Effectiveness Research.... Kaiser Permanente plans to put all of its 8.5 million members' health records on computer, a move that some experts predict "could set a new standard for American medicine." The above-mentioned Clancy calls Kaiser's move a "significant stride" in improving the efficiency of the health system.... Competition between PBMs over the last few years has reduced the discounts they can collect from pharmacy companies and, as a result, caused the savings they produce for HMOs to dwindle, according to the Philadelphia Inquirer. More than 100 PBMs currently operate in the United States.... A national single-payer system is being pushed in a House bill introduced by Reps. John Conyers and Jim McDermott. The bill would have the federal government finance, but not administer, the system.... Any payment system must deal with the health consequences of obesity, which could reach 40 percent in five years, according to a new study. An article in the journal Science says that Americans are gaining about two pounds a year. Currently, about 31 percent of the population is obese.
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.