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June 4, 2008

If It's Good Enough
for the Clintons. . .

Les Masterson, Senior Editor-Managed Care

I want you to think of your typical female 40-year-old member or patient. Is she married with two children? Does she drive a mini-van and take her children to Little League practice? Does she make all of the family's healthcare decisions? If you answered yes to all of these questions, your company may have a problem. [Read More]
 

 
Editor's Picks
Dispatches from The Bay State
There has been plenty of news from the Massachusetts healthcare experiment over the past week:

Aetna, CIGNA rank highest in efficiency
Hartford-based health insurer Aetna topped the list of more than 130 large health plans in the latest Athenahealth Inc., rankings. The rankings took into account how quickly and accurately insurers reimburse doctors. According to the survey, Aetna took 27 days on average to pay doctors, resolved 96% of claims on the first attempt, and denied 5.9% of claims. CIGNA finished in second. [Read More]
More young people going without health insurance
More than one-third of recent high school and college graduates are uninsured, according to a new Commonwealth Fund report. A total of 13.7 million Americans aged 19 to 29 were without health insurance in 2006, which increased from 13.3 million in 2005. Two-thirds of young adults without insurance claimed they went without care because of cost, and half reported problems paying medical bills or that they were paying off medical debts over time. Some states have responded to the gap in care by passing legislation that extends the age in which children can remain under their parents' health insurance—most notably New Jersey, which extended the age to 30. [Read More]
California legislators revive plans to expand healthcare insurance
The health insurance industry is in the crosshairs of the California Legislature. More than a dozen bills are in the Legislature, including ones that would require insurers to spend at least 85% of their earnings on patient care, mandate health services, and disallow policy cancellations of members who need extensive care. The legislation comes a year after the California Legislature defeated Gov. Arnold Schwarzenegger's healthcare proposal because of its price tag of $14.9 billion. [Read More]
 
Managed Care Headlines
Let Wal-Mart fix U.S. healthcare
MSN.com, June 2, 2008
Child healthcare varies widely among states
USA Today, May 28, 2008
CT governor urged to delay new health plan for uninsured adults
Hartford Courant, June 4, 2008
Hopkins says CareFirst owes $2 million in claims
Baltimore Business Journal, June 3, 2008
Effort to find ineligible Medi-Cal recipients worries some
AP/San Francisco Chronicle, June 2, 2008
Events
On Demand: Legal and Tax Implications of Incentive Program Designs
On Demand: Value-based insurance design: Alternative to high-deductible plans
On Demand: Cultural Diversity and Disease Management
 
 
Developments in DM
CMS Demonstration Targets Younger Seniors
Five demonstration projects are accepting participants in a three-year program to gauge whether preventive services reduce costs and chronic disease among younger Medicare beneficiaries. [Read More]
 
Listen Up
Tips for Better Managed Care Contracting
Nathan Kaufman, managing director and founder of Kaufman Strategic Advisors, offers advice and discusses the biggest mistakes that community hospitals make when it comes to negotiating managed care contracts. [Listen Now]
 
From HealthLeaders Magazine
Collect. . .or Else

HealthLeaders May 2008
A New York hospital's charge capture initiative gives the ED a financial boost. [Read More]
   
 
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