Physicians should learn how to talk to patients about money, according to a new study from Wake Forest University School of Medicine, especially as health insurers force people to base more treatment decisions on out-of-pocket costs. “Each year, doctors are finding more and more that patients are coming in carrying substantial deductibles and having to pay more out of pocket,” says Mark A. Hall, JD, a professor of law and public health and coauthor of the study. Doctors generally avoid asking patients about health insurance and finances, because they want what is best for their patients and what’s best may not always be the most affordable. The researchers say patients are counting on physicians to help guide them to the best treatment decisions — medically and financially.... Harvard Pilgrim, Tufts, and Grand Valley topped the U.S. News & World Report 2009–2010 rankings of commercial, Medicare, and Medicaid HMO and POS plans. The rankings are based on data collected and analyzed by the National Committee for Quality Assurance, managed care’s major accrediting and standards-setting body.… Findings from the STARD (Sequenced Treatment Alternatives to Relieve Depression) trial suggest that for second- and third-line treatment, no second generation antidepressant was superior to another in terms of effectiveness or of the overall incidence of harmful effects. Second generation antidepressants include serotonin and norepinephrine reuptake inhibitors. From a payer’s perspective, choice of antidepressant may be less important than close medication management in providing effective and tolerable treatment.
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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.