Aggressive glucose control does not reduce heart attacks in patients with type 2 diabetes, according to a study in the journal Diabetes Care. Such care does have “mixed short-term effects on microvascular complications,” the study states, adding that the results are consistent with recent clinical trials.... Ten million more CT scans might very well need to be covered by insurance companies, thanks to a ruling by the U.S. Preventive Services Task Force. The task force says that the scans may now be used on patients at high risk of lung cancer, smokers and former smokers age 55–80 who averaged a pack a day for 30 years, or those who averaged two packs a day for 15 years. That’s about 10 million people. The task force gave the recommendation a “B” rating and, under the Affordable Care Act, preventive services with such a rating must be covered.... Women at risk for coronary artery disease (CAD) are less likely then men to receive preventive therapies, such as lipid-lowering medication, and don’t get the same lifestyle advice either, according to a study in the journal Global Health. This, despite evidence that CAD kills at least as many women as men.
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.