CMS proposed new protections for Medicare beneficiaries in Medicare Advantage and prescription drug plans by providing more regulation on door-to-door marketing and cold-calling, as well as new proposed requirements pertaining to broker/agent commissions. The proposal goes beyond what the health care insurance industry recently endorsed as necessary regulatory changes to the program for development. “This is an important step to ensure beneficiaries can rely on information being provided to make Medicare coverage decisions that are right for them,” says Karen Ignagni, president and CEO of America’s Health Insurance Plans (AHIP). AHIP is reviewing the new regulations and is developing detailed comments… The age of a business may affect a manager’s decision to offer health benefits, according to a new report from the Henry J. Kaiser Family Foundation. The report suggests that for smaller and mid-sized establishments, the likelihood of offering coverage is positively associated with the age of the business. Insurers may want to give special focus to the issues faced by small businesses just starting up or in the early years of operation. Special subsidies or products for these businesses may be needed to encourage these businesses to purchase, and their workers to enroll in, health plans. The analysis is based on data from the insurance component of the Medical Expenditure Panel Survey… A recent study published in the British Medical Journal suggests that blood glucose self-monitoring is not cost-effective. In a randomized, controlled trial, 184 people with newly diagnosed type 2 diabetes were placed in either a self-monitoring group or in a control group that did no self-monitoring. Researchers found no significant difference in HbA1c, body mass index, or use of oral hypoglycemic drugs. However, patients in the self-monitoring group had higher on depression in the study’s well-being questionnaire.
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.