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November 7, 2007
Playing Nice
Brad Cain, Senior Editor-Managed Care

Always more a marriage of convenience than anything else, the social and legal contracts between health plans and providers are hitting on rough times. In high-profile cases from the East to the West coasts, providers are fighting back and are enlisting the help of state officials to rein in the actions of insurers. California regulators ordered the state's largest network model health plan to drop a controversial clause about provider confidentiality during contract negotiations. In New York, meanwhile, Cigna Corp. came to an agreement with the Attorney General's office to revamp its physician rating system. [Read More]

 
Editor's Picks
U.S. health insurers suggest Swiss, Dutch as prototypes
America's health insurers put the spotlight on their counterparts in Europe during briefings with policymakers and reporters. The briefings, sponsored by America's Health Insurance Plans, were part of an effort to demonstrate that not all countries with universal health systems have government-run programs. [Read More]
Romney health plan difficult to copy
The healthcare plan former Governor Mitt Romney implemented in Massachusetts would likely be impossible to replicate in most states without a tax increase because Massachusetts had a readily available $610 million "free care pool" to help provide coverage for the uninsured. [Read More]
Lawsuit over San Francisco health plan goes to court
A federal judge has heard arguments in a lawsuit centering on whether San Francisco employers should be required to help pay for a city program designed to provide healthcare for uninsured residents. [Read More]
Unlikely alliance forming on healthcare
The National Federation of Independent Business is expected to announce that it is signing up with a diverse political coalition promoting access to affordable healthcare for all. The leading small-business organization helped kill President Clinton's health plan in the 1990s. [Read More]
Managed Care Headlines
Report: WellCare probe involves expense reporting fraud
AP/Yahoo News, November 7, 2007
Is Canada's health system a cure for United States?
Dallas Morning News, November 7, 2007
California among worst in providing health insurance through jobs
San Francisco Chronicle, November 7, 2007
One in four Floridians lacks health insurance
Miami Herald, November 7, 2007
California mayors criticize Schwarzenegger's plan
AP/San Francisco Chronicle, November 7, 2007
Federal study offers dire outlook on child insurance
New York Times, November 7, 2007
Advocates tout rising support for child health plan
Boston Globe, November 7, 2007
Upcoming Events
Developments in DM

PGP Proving Its Worth: CMS' first pay-for-performance initiative for physicians within the Medicare program is turning the classic DM model of call center-based care on its head. The results of the first year of Physician Group Practice project, which ran from April 2005 to March 2006, shows two groups earned performance payments for quality and cost efficiency of $7.3 million as part of their share of the $9.5 million savings in the program. [Read More]
Listen Up
Getting Paid
The recent $20 million-dollar settlement involving UnitedHealthcare may impact more than just the Minneapolis-based plan. Neil Caesar, Esq., president of The Health Law Center in Greenville, SC, speaks about the landmark agreement and what it means for healthcare providers and managed care companies. He was interviewed by Les Masterson, managing editor for HCPro. [Listen Now]
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Resources From HCPro

Prove the ROI on your disease management program.
Find how to reach out to cultural populations and address healthcare disparities.
Discover checklists, forms, letters, and clauses to help you with managed care contracts.
Learn why consumer-driven healthcare is like a big hug.
Compare your capitation rates against national averages and help craft workable capitation contracts.
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