The conversion of not-for-profit Empire Blue Cross Blue Shield into for-profit WellChoice faces more challenges by consumer groups, who say that the deal violates New York's constitution. The Consumers Union says that the law allowing the deal benefited Empire, and Empire alone. A no-no, they claim.... Doctors' disciplinary files can now be found on the Internet in Washington state. But physicians aren't the only ones being scrutinized. The state's new web site lists pending and past actions against 260,000 health care professionals with state credentials.... Though physicians are prescribing fewer antibiotics, the ones they do prescribe are often too powerful for the condition, according to a recent study in the Annals of Internal Medicine. Researchers found that the number of prescriptions doctors wrote for antibiotics dropped 17 percent between 1991 and 1999. However, prescriptions for powerful antibiotics nearly doubled, from 24 percent to 40 percent.
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.