Industry focus on pricing, cost controls this year

January 1, 2010

Medicare cuts, quality measures and operational scrutiny is high on the list of insurers' other concerns in 2010

Insurers and payers will be watching a number of trends in 2010:

While most seniors will be able to enroll in some kind of MA plan this year, there were reductions in offerings in almost every state and county, according to analysis by Avalere Health. Attrition has been most noticeable with private-fee-for-service plans (PFFS), which face tighter regulatory requirements and payment cuts in the coming year. UnitedHealthcare and Universal American dropped nearly half their PFFS offerings, and several plans have exited the PFFS market completely. This retreat from the MA program is likely to accelerate.

This initiative has raised concerns about healthcare rationing, which was heightened even more just recently by the controversy over mammography screening recommendations from the U.S. Preventive Services Task Force, whose stance influences coverage of screening tests by Medicare and many insurers. Ideally, CER will curb spending on health treatments and services that appear ineffective and help develop practice guidelines accepted by health professionals.

Jill Wechsler, a veteran reporter, has been covering Capitol Hill since 1994.