Improving imaging test utilization is a hot topic among insurers and providers. The American College of Cardiology and UnitedHealth Group have joined to implement appropriateness criteria for the use of the single-photon emission computed tomography myocardial perfusion imaging test, which is used to evaluate patients with known or suspected coronary artery disease. . . . Pairing Zagat's methodology with WellPoint is the idea for the upcoming launch of a new online survey tool that will allow consumers to share their physician experiences with others. The Zagat survey methodology, which provides ratings for where to eat, drink, stay, and play, will allow WellPoint members to review and to evaluate physicians based on a set of distinct qualities. . . . California regulators moved to curb insurers' ability to cancel medical coverage after patients get sick, according to a report in the Los Angeles Times. The state's department of managed care and the department of insurance said they would propose rules that reinforce existing laws that forbid rescissions except when the insurer could show that a policyholder was at fault. The proposal would require insurers to check an applicant's health before issuing a policy in the first place.
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.