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May 21, 2008
Medical Home Takes on Water
Les Masterson, Senior Editor-Managed Care

Physicians and managed care don't agree on much, but there was finally one area in which they could find common ground-the advanced medical home concept. Praised by both constituencies as a way to improve patient outcomes and quality while reducing costs, the advanced medical home movement was sailing along calm waters until this month. Now, it is bouncing on the surface and its crew is feeling a little nauseous. [Read More]
 

 
Editor's Picks
1,200 CA residents to have healthcare coverage restored
Kaiser Permanente and Health Net agreed to reinstate health insurance coverage to nearly 1,200 people whose policies were canceled. The deal, brokered by the California Department of Managed Health Care, will allow former members of those health plans whose coverage was rescinded since 2004 to purchase new insurance regardless of preexisting medical conditions. The settlement comes three months after a woman won a $9 million judgment against Health Net for canceling her coverage while she underwent chemotherapy. California is seeking similar deals with Anthem Blue Cross, Blue Shield, and PacifiCare. [Read More]
UnitedHealth Group, Sierra Health Services deal challenged
A number of groups have come together to oppose the biggest healthcare deal in Nevada history. Service Employees International Union Nevada, the American Medical Association, Nevada State Medical Association, and Clark County Medical Association filed documents with the federal Justice Department and U.S. District Court to oppose UnitedHealth Group Inc.'s $2.6 billion purchase of Las Vegas-based Sierra Health Services Inc. Opponents of the deal say the purchase could leave consumers vulnerable as it would allow UnitedHealth to acquire 90% share of the region's health maintenance organization market. The Justice Department has already stated it will allow the purchase to go forward if the companies divest assets related to UnitedHealth's Las Vegas Medicare Advantage. [Read More]
Florida governor signs autism health insurance coverage bill
Florida Gov. Charlie Crist signed legislation this week to require health insurers to cover autism. The mandate asks health insurance companies to negotiate agreements with the state on how they will cover diagnosis and treatment of autism-related disorders. The move comes less than a month after the Florida Legislature approved healthcare reform that included provisions to offer mandate-lite health policies. Those policies do not require some state-mandated coverage, such as transplants and hospital-day requirements, and mandate-lite advocates say the plans allow people to buy cheaper health insurance plans. [Read More]
 
Managed Care Headlines
Judge rules against Blue Cross of Michigan on rate hikes
Detroit Free Press, May 10, 2008
New Jersey bill aims for universal health coverage by 2011
Philadelphia Inquirer, May 16, 2008
Connecticut Democrats press for small-business health plan
Hartford Courant, May 21, 2008
Billing issue leaves patients feeling ill
Los Angeles Times, May 19, 2008
Court rejects North Texas Specialty Physicians' appeal of FTC ruling
Fort Worth Star-Telegram, May 20, 2008
MA health plans' results in first quarter are just mediocre
Boston Globe, May 16, 2008
Upcoming Events
On Demand: Legal and Tax Implications of Incentive Program Designs
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On Demand: Cultural Diversity and Disease Management
 
Listen Up
Fate of CDH
Lincoln Smith, president and CEO at Altarum Institute, a nonprofit research group that offers objective health systems research and solutions, talks about which populations benefit from consumer-driven health plans and what he sees as the future of those plans. [Listen Here]
 
Developments in DM
DMAA Hopes Congress Will Step in on MHS
With the Centers for Medicaid & Medicare Services' Medicare Health Support program scheduled to end this year, DMAA: The Care Continuum Alliance is focusing its efforts on Congress in an effort to extend the five pilots still remaining in the program. [Read More]
 
 
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