PPOs participating in Medicare Advantage can satisfy federal oversight requirements if they've already received accreditation from the National Committee for Quality Assurance, according to a ruling by the Centers for Medicare and Medicaid Services. The Medicare reform law passed last year will make regional PPOs available to beneficiaries in 2006. NCQA accreditation is already being used by 50 of about 150 participating HMOs to meet federal requirements.... Though most plans cannot gauge the exact financial return from their Web sites, they consider having an online presence to be a valuable commodity, according to a new Capgemini report. "More payers view their sites as an effective way to market new products, like consumer-directed plans, not just in lowering administrative costs," says Peter Kongstvedt, MD, Capgemini's vice president. The findings result from an analysis of 97 health plan Web sites.
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.