Policies that create environments that support healthier eating, lower sodium consumption, and increased physical activity offer greater promise of reducing hypertension than does merely educating people about the dangers of high blood pressure, according to the Institute of Medicine’s “A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension.” And who could argue, when nearly one third of all U.S. adults have hypertension, which accounts for about 1 in 6 adult deaths annually.... Medical practice leaders are dissatisfied with Medicare’s Physician Quality Reporting Initiative (PQRI), according to the Medical Group Management Association’s recent member survey. The respondents cited arduous administrative challenges when trying to review feedback reports. And when those reports are reviewed, doctors express little to no satisfaction with the reports themselves.... Speaking of reports, a new one from the Department of Health and Human Services lists premium rate hikes requested by insurers in Connecticut, Maine, Michigan, Oregon, Rhode Island, and Washington. “America’s largest insurance companies have requested premium increases of 56 percent in Michigan, 24 percent in Connecticut, 23 percent in Maine, 20 percent in Oregon, and 16 percent in Rhode Island,” says HHS Secretary Kathleen Sebelius.
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.