Inhaling steroid medications might not be necessary, according to a study that finds no difference in outcomes for people with asthma who took the drugs each day or only when symptoms occurred. “The discovery that these two courses of treatment do not differ significantly could eventually change the way doctors and patients manage asthma, providing an option that is easier to follow and possibly less expensive,” says William Calhoun, MD, of the University of Texas Medical Branch at Galveston, and lead author of the study that appears in the September 12 issue of the Journal of the American Medical Association.... The 16 million new beneficiaries expected to flood Medicaid rolls in 2014 as a result of the Affordable Care Act might have a tough time finding doctors, according to a study in Health Affairs. Physicians in many parts of the country are wary of accepting new Medicaid patients because of what they perceive as unfair pay — Medicare pays much better. Another development: State participation in the expansion of Medicaid is optional under the Supreme Court’s ruling on the ACA, and some governors are leaning against it.... Physicians are in such high demand that they should be wary of just shooting their resume and C.V. out willy-nilly, because they could be inundated with responses, says physician recruiter Jim Stone of the Medicus Firm. Stone tells amednews.com that “Just shotgunning their C.V. out can result in a lot of extra work on their part.” A doctor posting on the job board of the National Association of Physician Recruiters (Stone is president-elect) might receive 200 to 500 responses within 48 hours. Nice to be wanted.... Insurers and employers cannot deny coverage or benefits to transgender people, according to a ruling by the Department of Health and Human Services. Citing Section 1557 of the ACA, the ruling says that the “sex discrimination prohibition extends to claims of discrimination based on gender identity or failure to conform to stereotypical notions of masculinity or femininity....” However, in further clarification, the HHS says that this does not mean that insurers have to cover gender transformation surgery.
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.