HCPro Health Plan Insider - July 30, 2008 | Connecting with Prevention View as a Webpage | Subscribe for Free
July 30, 2008
Connecting with Prevention
Les Masterson, Senior Editor-Managed Care


Not long ago, employers tackled bulging health costs one way—by shifting more costs onto employees. There is still plenty of cost shifting taking place in employee health insurance, but businesses are turning to health and wellness programs as a way to both reduce healthcare costs and improve employee health. A report released last week is giving employers some pointers as to how to create programs that engage workers. [Read More]
 

 
Editor's Picks
Judge approves settlement in Health Net case
Health Net will pay $215 million to patients who allegedly received low reimbursements for out-of-network claims after a federal judge in New Jersey approved the settlement of three class-action lawsuits. The case involved two million members and charged that consumers paid more because Health Net used an "invalid" database provided by UnitedHealth Group-owned Ingenix. New York Attorney General Andrew Cuomo launched an investigation into the subject of out-of-network claims earlier this year. [Read More]
Minnesota governor unveils plan to revamp healthcare system in the state
Minnesota Gov. Tim Pawlenty is proposing healthcare reform in a much different flavor than Massachusetts' ambitious plan. Pawlenty's proposal would give all Minnesotans access to online personal health portfolios by 2011 and debit cards for flexible spending accounts. The governor said the proposal is in the formulation stage, and he plans to hold town hall forums to gather suggestions. [Read More]
Medicare Part D a boon for drug companies, House report says
Drug companies are profiting off the Medicare Part D program, according to a House committee. The House Committee on Oversight and Government Reform reported taxpayers are paying up to 30% more for prescription drugs under Medicare Part D than under the government's Medicaid program. Since Medicare Part D was enacted two years ago, drug companies have gained $3.7 billion more than what they would have made under the Medicaid program, according to the House committee. Chairman Henry A. Waxman said he will file legislation that would forbid higher prices under Medicare Part D than under Medicaid. [Read More]
Private medical data exposed in Georgia
Blue Cross and Blue Shield of Georgia may have violated the Health Insurance Portability and Accountability Act when it reportedly sent an estimated 202,000 benefit letters containing personal and health information to the wrong addresses last week. The mailings were mostly Explanation of Benefit letters that included the patient's name and ID number, the name of the medical provider, and the amounts charged and owed. A Blue Cross spokeswoman said a "small percentage" of letters also contained patient Social Security numbers. The company said the problem may have been caused by a change in the computer system that was not properly tested. [Read More]
Looking for capitation data
We are collecting data for the 2009 Capitation Rates & Data survey, and need your help so we can provide the most meaningful data possible. Health plans that offer capitated service are invited to take our 2009 Capitation Survey Questionnaire. Please print the survey, fill it out, and mail it to Les Masterson, HCPro, 200 Hoods Lane, Marblehead, MA 01945. Or fax to Les' attention at 781-639-2982. The first 20 people who respond to the survey will receive a $5 Starbucks Card. We will release the survey results in a publication later this year and I will feature them in an upcoming column.
 
Managed Care Headlines
Insurers increasingly going against doctors' orders
Bloomberg News/Hartford Courant, July 29, 2008
Massachusetts House proposes $89 million in health fees
AP/Boston Globe, July 30, 2008
Massachusetts coalition fights fee plan for insurers
Boston Globe, July 24, 2008
Some cancer patients at New Jersey center may have to move
Newark Star Ledger, July 28, 2008
Abuse cited as Massachusetts insurer halts sales to seniors
Boston Globe, July 28, 2008
Indiana campaign aims to get kids, adults health insurance
AP/Chicago Tribune, July 24, 2008
Massachusetts insurers to cover drugstore clinic visits
Boston Globe, July 24, 2008
Temple University doctors in insurance impasse
Philadelphia Inquirer, July 25, 2008

Events/Audioconferences
On Demand: Health Literacy: Four Ways to Create a Successful Program
On Demand: Legal and Tax Implications of Incentive Program Designs
On Demand: Value-based insurance design: Alternative to high-deductible plans
 
Listen Up
Healthy Anxiety
Author Robert Rosen explains how leaders can turn anxiety into productivity. [Listen Here]
 
Capitation Corner
PROMETHEUS payment model aims to top capitation
PROMETHEUS is gaining traction as providers and payers become increasingly frustrated with the limitations of today's healthcare payment systems. Neither a FFS nor a risk-based system, PROMETHEUS aims to facilitate better clinical coordination throughout the healthcare delivery system by paying each provider according to its contribution to a patient's care and introducing efficiencies designed to increase overall payment streams. [Read More]
 
From HealthLeaders Magazine
The Hospital of the Future

HealthLeaders July 2008
Sure, your organization offers sophisticated, compassionate care. But the patients of tomorrow will want much more than that. Here's how some hospitals are creating facilities for a new vision of healthcare. [Read More]
   
 
Sponsor Health Plan Insider

Contact Lisa Brown, Director of Integrated Sales, at lbrown@healthleadersmedia.com or call 781.639.1872.
 
Resources From HCPro

Gain the knowledge of two disease management publications at a discounted price.
Learn how to educate and engage members.
Read about practical strategies for maximizing the effectiveness of health and disease management programs.
Discover how you can dramatically reduce costs by aggressively managing chronic disease states.
Find out how to drive behavior change through incentive plan design.
 
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