One in 13 U.S. adults who needed to see a specialist reported access to be a “big problem,” according to a recent News and Numbers report by the Agency for Healthcare Research and Quality. Participants reported various reasons for difficulty getting specialty care, including lack of health insurance, specialist nonparticipation in patients’ insurance plans, difficulty contacting specialists, long waits to get an appointment, and inconvenient specialist location.... The Centers for Medicare & Medicaid Services has selected the American College of Radiology (ACR) as a designated accrediting organization for medical imaging facilities. ACR is able to satisfy all accreditation requirements for providers of advanced medical imaging mandated by the Medicare Improvements for Patients and Providers Act of 2008.... Episode-based payment is gaining some traction as a consensus grows that true health care reform will require a move away from fee-for-service payments. A policy analysis conducted by researchers at the Center for Health System Change and Mathematica Policy Research identifies key policy considerations involved in designing and implementing an episode-based payment system that would bundle payment for some or all services delivered to a patient for an episode of care for a specific condition over a defined period. The analysis is titled “Episode-Based Payments: Charting a Course for Health Care Payment Reform” and can be found at http://nihcr.org/EpisodeBasedPayments.html.
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.