Pay for performance so far has been only a stopgap measure to fix the fundamentally broken payment system, according to a report issued by PricewaterhouseCoopers' Health Research Institute. The organization found that there is little quantifiable effect on health care quality, outcomes, and efficiency and there are insufficient financial incentives to change physician behavior. Findings were based on in-depth interviews with top executives of 10 of the nation's largest commercial payers.... The underinsured account for 24 percent of the United States population, according to a survey in Consumer Reports. This population lives with health coverage that barely covers medical needs, and leaves them unprepared to pay for medical expenses. Forty-nine percent of people overall, and 43 percent of people with insurance, said they were "somewhat" or "completely" unprepared to cope with a costly medical emergency in the coming year.... Communicating with employees is the greatest challenge employers face when introducing a consumer-directed health plan, according to the consulting firm Watson Wyatt. The sparse information about provider cost and quality is another obstacle that hampers consumer-directed health care acceptance. A study jointly conducted with Rand showed that specific resources needed to help workers evaluate the cost and quality of care are often lacking. Just 2 percent rated cost information about providers as "excellent" and only 5 percent rated it as "good."
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.