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Insurers tout disease management programs, but critics are wary

Washington Post, July 19, 2010

Starting next year, most health insurance plans will be required to spend 80% to 85% of the premiums they collect on medical claims or other activities that improve members' health. Profits and other costs such as administrative expenses must account for no more than 15% to 20%. The Obama administration is drafting regulations that will determine which, if any, disease management programs insurers will be able to count as improving members' health. Consumer advocates argue that only programs whose effectiveness has been scientifically proven should be included. But insurers warn that if the rules are so strict that most of their disease management programs don't qualify, they will be forced to curtail or even drop them.