The majority of physicians surveyed about health care financing by the Indiana University School of Medicine were in favor of government legislation to establish national health insurance. Fifty-nine percent of the 2,200 physicians were in favor, while only 32 percent opposed it. . . . Barriers still remain among hospitals, physicians, and health plans when it comes to sharing patient clinical data electronically. A survey by the Center for Studying Health System Change identified two factors that are slowing down adoption of health information exchanges: concerns with data misuse and loss of competitive advantage. These organizations support the electronic sharing of clinical data among independent hospitals, physicians, and other health care stakeholders in a community. . . . Acupuncture may be a complement to some medical services and pharmaceuticals, a finding that may be of interest to insurers, providers, and policy makers, according to an article published in the journal Medical Care. Researchers analyzed managed care claim data from a midsize metropolitan insurance company. They concluded that the fact that acupuncture has an effect on other medical services needs to be explored more fully with an emphasis on how the additional use of this procedure affects patient health.
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.