Some eye-popping charts (http://bit.ly/xGEMTc) from the International Federation of Health Plans tell a familiar story in a new way. Health care costs more in the United States than it does in other countries. The IFHP reviewed costs in nine countries and found that the average price for 20 common medical procedures, test, scans, and treatments in the United States far exceeded prices elsewhere. The range was the greatest for surgery. For instance, coronary artery bypass surgery ranges from about $5,000 in India to about $68,000 in the United States.... Pap smears need not be done every year, according to guidelines released last month by the U.S. Preventive Services Task Force. Women ages 21–65 should get a test every three years. Women ages 30–65 have the option of getting a pap smear every five years if they are tested for the presence of human papillomavirus (HPV) at the same time. Providers and patients who are used to more frequent testing may have qualms about the USPSTF guidelines.
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.