A significant number of office-based physician practices have yet to implement an electronic health record (EHR), according to Sage Healthcare Division, a developer of EHRs. But their implementation “continues to grow as an increasing number of physicians and staff gain a better understanding of the efficiency and cost-saving benefits,” according to a recent company survey. It notes that federal “meaningful use” incentives are still one of the strongest drivers for most physicians (64 percent) to implement EHR technology, but for 32 percent of those who are in the market for an EHR, insufficient capital is still a key challenge.… The Government Accounting Office surveyed officials in insurance departments in all the states and the District of Columbia about their practices for overseeing premium rates in 2010 and changes they have begun making to enhance their oversight. The GAO noted widespread variability in reviewing, approving, or disapproving rate filings submitted by insurance carriers. Respondents from 38 states reported that all rate filings were reviewed before the rates took effect, while others reported reviewing at least some rate filings after the rates took effect. The types of information they reported reviewing varied, too. For example, nearly all reviewed trends in medical costs and services, but fewer than half reported reviewing carrier capital levels compared to state minimum levels.... Transitions in care are vulnerable periods for patients during hospitalization and a new study suggests admission to the intensive care unit is associated with an especially high risk of medication discontinuation. A study in the August issue of the Journal of the American Medical Association found that patients admitted to the hospital were more likely to experience unintentional discontinuation of medications than a control group. This applied across all medication groups examined. Getting admitted to an ICU was associated with greater risk of medication discontinuation than when hospitalization was not through the ICU, the researchers found.
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.