Small and medium-sized physician practices use just one-fifth of patient-centered medical homes’ processes. On the other hand, large practices and those owned by hospitals or HMOs use more medical home processes, like chronic disease registries or nurse care managers. Results were published in the August issue of Health Affairs.… This year’s new flu vaccine formulation has been approved by the Food and Drug Administration. This formulation will be used by the six manufacturers licensed to produce and distribute the vaccine for the 2011–2012 flu season. Between 5 and 20 percent of the U.S. population develops influenza each year, leading to more than 200,000 hospitalizations from complications, according to the Centers for Disease Control and Prevention…. How well have states been doing in creating health insurance exchanges? A new report by the Henry J. Kaiser Family Foundation says that “some states have already taken major steps towards establishing an exchange, while other states have struggled to pass legislation or have opted not to begin the process of establishing one.”
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.