Even as health plans tout their ratings of the quality of their hospitals and other providers, it’s not surprising that hospitals, at least, are returning the favor. A survey released by Davies Public Affairs measured hospital executives’ perceptions of the nation’s largest health insurance companies.

United Healthcare generated particularly intense responses among hospital executives. The Minneapolis-based insurer garnered an unfavorable opinion from 91 percent of executives polled. This compares with an average unfavorable rating of 41 percent for all other insurers. Lest you think this is an anomaly, last year 87 percent of participants said United Healthcare was “difficult” or “very difficult” to deal with. Maybe this is just sour grapes for executives who are picking on United Healthcare because it is tight-fisted? But no, that’s not the case.

United’s “reimbursement rates were not significantly lower than other major payers,” says Brandon Edwards, president and chief operating officer of Davies. “They are viewed as untrustworthy and dishonest. This was an unanticipated finding.”

Cheryl Randolph, spokeswoman for United Healthcare, says, “While we welcome productive evaluations from our customers and network providers, we are disappointed that this narrow survey fails to fairly represent the good relationships that United Healthcare has with most hospitals.” The survey results are based on 113 interview respondents representing more than 500 hospitals, or about 10 percent of all hospitals in the United States.

The request

Source: Davies Public Affairs

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.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

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?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

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.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

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.