Developing quality benchmarks for consumer-directed health plans will be the mission of a committee launched by the American Accreditation HealthCare Commission, which is still primarily known by its original acronym, URAC. "We recognize that consumer-driven health care is still in its infancy and that there is not yet consensus on quality benchmarks," says Garry Carneal, URAC's president and CEO. URAC wants to launch the new accreditation program by the end of this year.... Guaranteed health insurance for every American should be a reality by 2010, says the Institute of Medicine. This is the first time the IOM has recommended universal coverage. Unfortunately, the IOM committee that came to this conclusion fails to describe just how society can go about achieving this elusive goal.
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.