This Week in Managed Care: January 23, 2016

Top managed care stories this week included UnitedHealth reporting larger-than-expected losses on Affordable Care Act health plans, new guidelines from the government that will improve patient access to medical records, and new information that can reduce risk of diabetes.

Hello, I’m Justin Gallagher Associate Publisher of The American Journal of Managed Care. Welcome to This Week in Managed Care, from the Managed Markets News Network.

UnitedHealth Loses Big on ACA Plans

This week, UnitedHealth reported that its losses from selling policies on health insurance exchanges were worse than expected. Losses for 2015 were $720 million, and the two-year total through 2016 is expected to top $1 billion, the company said.

Dan Schumacher, UnitedHealthcare’s chief financial officer, said losses are higher than expected because UnitedHealth is attracting patients who are sicker than average, and too many patients are signing up outside the open enrollment window.

UnitedHealth has demanded that the Obama Administration make changes to the Affordable Care Act exchanges in 2017, including limiting the hardship exemptions. Otherwise, it may leave the health exchanges, which would give consumers who buy coverage there fewer choices in many markets.

Improving Patient Access to Medical Records

Recent updates to the Health Insurance Portability and Accountability Act, better known as HIPAA, will make it easier for patients to gain access to their medical records.

The Obama administration is responding to complaints, but it also hopes that patients who have more information about their own medical history will experience fewer errors or won’t end up with duplicate tests. Having easy access to medical records is also an essential part of precision medicine.

The new rules protect consumers in several areas:

  • Providers can charge for copies, but not for researching records.
  • Patients can ask to have records sent by email or regular mail. They can’t be forced to pick them up in person.
  • Providers have 30 days to provide records in most cases.

USPSTF Guidelines Remain Controversial

The US Preventive Services Task Force has updated its recommendations for breast cancer screening, but the controversy remains. The task force continues to find insufficient evidence of benefit or harm for giving every woman between ages 40 and 50 a mammogram, and advises an individualized approach, based on risk factors, for women younger than 50 years.

For those 50 to 74, a screening is recommended every 2 years. Many experts take issue with the recommendations, because breast cancer that strikes women in their 40s is typically very aggressive.

In a commentary, radiologist Dr Michelle Rivera writes that the absence of a radiologist or breast cancer specialist on the Task Force is a notable gap: “Given all of the data showing that routine screening beginning at age 40 saves the most lives, I cannot understand why the USPSTF would deny women a fighting chance.”

Sleeping In

If you don’t get any sleep during the week, take heart: you can recover on the weekends.

A study in the journal Diabetes Care found that a group of young men who were only allowed to sleep four-and-half hours a night for 4 days were already showing signs of insulin resistance and producing more insulin, which puts the body at increased risk of diabetes. However, 2 days of extended sleep—more than 9 hours each night—restored them to normal levels.

The study is one of many being done today to examine how sleep deprivation or shift work puts people at risk of diabetes and obesity. For more, read the story.

Patient-Centered Diabetes Care 2016

Don’t forget to register for our upcoming meeting, Patient-Centered Diabetes Care, which is coming to Teaneck, New Jersey April 7th and 8th. Our faculty are joining us from all parts of the country, with innovative ideas on managing this disease. Register now.

For everyone at the Managed Markets News Network, I’m Justin Gallagher. Thanks for joining us.

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