The National Association of Insurance Commissioners announced the availability of the inaugural issue of the Accident and Health Policy Experience Report. The report collects countrywide and company-level information on premiums, loss ratios, number of policies, number of covered lives, and market share. The report is intended as an assessment tool for state regulators. A copy can be ordered at http://www.naic.org/store_home.htm.... For the seventh consecutive year Harvard Pilgrim Health Care has been named the number one private health plan in the United States by the National Committee for Quality Assurance. The ranking is based on measures of prevention, treatment, and customer service. Success must run in the family because the health plan’s New Hampshire affiliate, Harvard Pilgrim Health Care of New England, is the third highest rated private health plan.... Kathleen Sebelius wrote to America’s Health Insurance Plans, accusing it and its members of using scare tactics and misinformation and falsely blaming premium increases for 2011 on the patient protections in the Patient Protection and Affordable Care Act. In the letter, the HHS secretary said that the consumer protections and out-of-pocket savings provided in the health care reform law should result in a “minimal impact on premiums for most Americans.”
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.