The Year in Managed Care: Top Stories Revisited

The past 12 months have brought significant and radical change in the healthcare industry. Here are some of the top stories of 2012 revisited.

The top story of 2012 was unquestionably the Supreme Court’s decision to uphold the 2010 Patient Protection and Affordable Care Act (PPACA). By joining the four liberal justices on the court, Chief Justice John G. Roberts Jr. provided the key vote that upheld the individual mandate, the key piece of the PPACA, requiring Americans to purchase health insurance. The mandate was deemed constitutional under Congress’ power to lay and collect taxes.

Aside from the historical significance, the decision brought with it a plethora of additional considerations. For instance, medical spending and quality of care were two major focal points following the Supreme Court’s decision. States were left to ponder the pros and cons of Medicaid Expansion. Additionally, individual states were also left to grapple with the decision of whether or not to implement their own health insurance exchange (HIX). Even today, legislative and economic challenges still exist, causing some states to refuse any part in setting up a HIX, while others continue to move forward thanks to government grants.

But beyond the fallout from the Supreme Court’s decision, there were many other significant stories in managed care in 2012. Some of those include the following:

• Recently, the Supreme Court has also decided to investigate the controversial “pay for delay” model that seems to be gaining popularity.
• New revenue models were also debated throughout the year. Accountable Care Organizations (ACOs) have become the media darling of the bunch, and the incentives provided by ACOS in the form of shared savings have this model gaining momentum despite some notable risks.
• In early 2012, payers and providers were scrambling to figure out how to transition from ICD-9 codes to the new ICD-10 system by the original deadline of October 1, 2013. Fortunately, this deadline was delayed, but there are still many concerns related to the transition.
• Improving readmission rates in hospitals was a key topic this past year. Readmission penalties were a hotly debated topic, and the mixed reactions were well documented.

Finally, the past year included many managed care conferences that brought with them new data on revenue models, cost savings, personalized medicine, and much more. The AJMC editorial team had the privilege of covering many of these conferences on site to bring the latest information to readers. Here are some of the highlights:

• With so many burgeoning areas of science coming together to help advance personalized medicine, there was no shortage of topics at the Center for Business Intelligence’s (CBI) 4th Annual Forum for Payers on Personalized Medicine conference in March. In short, personalized medicine continues to make steady progress.
• The Academy of Managed Care Pharmacy’s 24^th Annual Meeting in San Francisco this past April featured sessions on drug shortages, medication adherence trends, and oncology pathways.
• The America’s Health Insurance Plans (AHIP) Medicare and Medicaid Conference took place in Washington, DC in September. Topics included financial incentives and other health reform initiatives; Medicaid reform and expansion; and delivery systems to improve patient care. In addition, the AHIP Fall Forum 2012 conference took place in Chicago, IL, from December 3-5, and featured discussions on patient engagement and technological advancements in healthcare.
• Finally, 2012 also featured The American Journal of Managed Care’s first live meeting, "Translating Evidence-Based Research into Value-Based Decisions in Oncology." The conference, which brought together stakeholders from all sides of the managed care industry, provided an arena for healthcare professionals to discuss new, innovative payment models being utilized by both payers and providers. (For an in-depth look at all the sessions from this conference, please click here.)
• For a complete list of conferences covered by the AJMC editorial team in 2012, please visit the conference landing page.

The past 12 months have brought about an unprecedented amount of change in the healthcare arena. In many instances, change is just beginning, meaning that 2013 and beyond will bring about continued change, as stakeholders from all sectors of the healthcare industry come together to examine new strategies to deliver better care while reducing costs. As always, we look forward to bringing you the latest information as the industry continues to evolve.