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December 12, 2007
Managing Relationships
Brad Cain, Senior Editor-Managed Care

There are primarily two paths to growth in this or any industry. There's the organic variety whereby you grow your business through marketing, outreach and expansion into new regions. And then there's the fast-track approach of growing through acquisition. The former entails a process of building relationships with business partners--be they providers, employers or individual enrollees--while the latter is based on acquiring a set of ready-made relationships. Success via the acquisition route, however, is dependent upon the successful integration of these relationships into your own operations. And there's the rub. [Read More]

 
Editor's Picks
Humana on hot seat for Medicare practices
Earlier in 2007, the state of Oklahoma used its limited authority to fine Humana almost as much as the federal government has fined all Medicare Advantage players combined. The state felt that it had uncovered serious abuses that deserved far harsher punishment from the federal government, and now frustrated state commissioners are increasingly calling for reforms. [Read More]
Prospects for overhauling California healthcare look poorer
An expected vote on legislation overhauling California's $170 billion healthcare system has been postponed indefinitely. Gov. Arnold Schwarzenegger and legislative leaders continue to disagree on elements of the plan from tax subsidies to insurance reform. [Read More]
Pennsylvania governor playing tough with insurance
Pennsylvania Gov. Ed Rendell has threatened to withhold state aid to help doctors and other medical professionals pay malpractice insurance unless lawmakers act on his proposal to expand state health insurance. [Read More]
Nearly 300,000 in Massachusetts seek coverage under law
Nearly 300,000 Massachusetts residents have obtained health insurance through the state's initiative that mandates all residents to get insurance unless the state determines it is unaffordable for them. The state's initiative is being watched across the nation as other states consider how to move forward in the absence of any federal solution to the growing number of uninsured. [Read More]
Managed Care Headlines
Study finds insured Iowans have high health costs
Des Moines Register, December 6, 2007
Coalition argues health insurance costs across Wisconsin unequal
Milwaukee Journal-Sentinel, December 5, 2007
Health care execs float plan for the uninsured
New Orleans Times-Picayune, December 5, 2007
Proposal for universal health insurance in New York State
New York Times, December 6, 2007
Kaiser wins trauma center battle
Sacramento Bee, December 12, 2007
Two insurers increase bet on Medicare
New York Times, December 5, 2007
Massachusetts tax group sees big healthcare hit to employers
Boston Globe, December 7, 2007
Upcoming Events
Developments in DM

Value-based option improves medication compliance: Passing on costs to consumers may help the bottom line in the short term, but a growing number of healthcare experts are concerned that higher copays only create more costs in the long run. A growing number of healthcare experts are offering an alternative to high-cost plans--value-based insurance design. [Read More]
From HealthLeaders Magazine
Contract Clarity
Providers and health plans aren't always known for close collaboration with one another. But a new Colorado law designed to increase transparency between physicians and managed care organizations has support from both sides. [Read More]
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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.
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Compare your capitation rates against national averages and help craft workable capitation contracts.
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