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Letter from the Editor, #691: Health Exchanges Coming Soon

Aug 23, 2013
We are moving closer to the beginning of the Health Exchanges and it appears that many of the health plans will offer substantially smaller networks of hospitals and physicians than current health plans generally offer. Enrollees in such plans will have limited or no coverage if they seek care outside their plan network. However, subscribers will enjoy lower premiums than they would pay for plans with broader networks, insurers say. 
Insurers including Aetna and Health Net believe millions of exchange subscribers of modest incomes will accept these narrower networks, made up of hospitals and physicians selected using cost and patient-outcomes criteria. They increasingly have offered such plans to employer groups over the past few years, touting annual cost savings of 10% to 25%. In the large-employer market, Aetna’s narrow panels are 15% to 35% smaller than its standard preferred provider panels. Blue Cross and Blue Shield of Illinois says its exchange plans using narrow networks will cost 20% to 30% less than its exchange plans with bigger networks. Insurers say they are able to charge lower premiums for narrow-network plans because they can select more cost-effective providers, and in some cases they are able to pay them lower reimbursement rates in exchange for funneling more patients to them. 
On the flip side Dr. Reid Blackwelder, president-elect of the American Academy of Family Physicians, said that family physicians need to work in tandem with specialist physicians whose work they know and trust and that health plans whose provider networks are too small could make it more difficult to do that.  

While talking to some of our readers I found that a lot to them are putting their type 1 patients on a GLP-1 analog. This is not indicated and while some patients get great results it does not look like this class is good for all type 1 patients. A study from Kevan Herold, MD, of Yale University sheds some light on the question Does Byetta Work for Type 1’s?


From "dLife visits a Native American family that has been hit hard with diabetes; Chef Michel Nischan shows us how to make a delicious, whole chicken in the slow cooker. dLife investigates how some children have paid the ultimate price for their parents’ religious views." Sundays live online at at 7 PM ET, 6 PM CT, and 4 PM PT. Keep up on the latest dLife news at
With a day packed full of education, motivational tools, one-on-one sessions, and workshops, the TCOYD health fair is a great way to get your patients to take better care of their health and themselves.

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Dave Joffe, Editor-in-chief