Sixty-three percent of health care providers expect electronic health records to have “a lot” or a “tremendous” impact on improving health care, according to the IVANS 2008 Healthcare Provider survey. Twenty-seven percent of respondents said EHRs would have some effect on improving health care, 6 percent said EHRs would have little effect, and 4 percent said EHRs would have no effect. . . . The United States Census Bureau reported in its Annual Social and Economic Supplement that both the percentage and number of people without health insurance decreased in 2007. The percentage without health insurance was 15.3 percent in 2007, down from 15.8 percent in 2006, and the number of uninsured was 45.7 million, down from 47.0 million. It further reported that the percentage of people covered by private health insurance was 67.5 percent, down from 67.9 percent in 2006. Further highlights show that the percentage of people covered by employment-based health insurance decreased to 59.3 in 2007 from 59.7 percent in 2006. The number of people covered by employment-based health insurance, 177.4 million, was not statistically different from 2006. . . . Quality Compass 2008, the NCQA’s compilation of clinical performance and patient experience, is now available. It’s the first time that individual preferred provider organization plan data will be included in the compilation. “Two-thirds of privately insured Americans receive their coverage through PPOs,” says NCQA chief information officer Rick Moore. “The inclusion of this data allows decision-makers in the health plan contracting cycle make meaningful comparisons among both health maintenance organizations and preferred provider organization plans.”
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.