HCPro Health Plan Insider - January 14, 2009 | Three Takeaways from the MHS Project—So Far View as a Webpage | Subscribe for Free
Three Takeaways from the MHS Project—So Far
Les Masterson, Senior Editor-Managed Care

CMS' second interim report on the Medicare Health Support project provided reasons why CMS ended the project last year, but what can the disease management industry learn from the pilot? One of the organizations that took part provides three takeaways from the DM project. [Read More]
  January 14, 2009

 
Editor's Picks
UnitedHealth settles suit over systemic underpayment
In a shakeup that will affect every health insurer, a settlement between UnitedHealth Group and New York Attorney General Andrew M. Cuomo will create a new independent database that will determine out-of-network costs. Cuomo's office investigated UnitedHealth's Ingenix business unit, which operates the industry's databases, following complaints that health insurers were underpaying for services. The settlement calls for a new independent database, run by a yet-to-be-determined university. UnitedHealth did not acknowledge any wrongdoing in the settlement and stands behind the quality of information in its database. [Read More]
Unemployed squeezed on health insurance
Recently unemployed Americans spend nearly one-third of their jobless benefits on COBRA health insurance, according to Families USA. For those who cover their families, that number jumps to more than 80% of the individual's unemployment check. In fact, in nine states, the average premium for family coverage equals or exceeds unemployment benefits. In response, President-elect Barack Obama is proposing to spend about $80 billion to extend unemployment benefits and to subsidize healthcare for people who have lost their jobs. [Read More]
California ruling removes billing headache from emergency room visits
The California Supreme Court ruled against balance billing for emergency room care last week, but questions remain about what constitutes reasonable payment for emergency services. Health insurers and patient advocates praised the court's decision as a protection against hospitals and physicians charging patients for emergency care not paid by insurers, but physicians are concerned the decision will result in insurers underpaying them for care. [Read More]
California probes whether Kaiser call centers endanger patients
After fielding a complaint from a nurse that Kaiser Permanente's call center mishandled calls that put members at risk, the California Department of Managed Care has launched an investigation of the health plan's call centers. The nurse who reported the issue claimed that at least one patient died as a result of the actions of a Kaiser Permanente call center employee. State officials have requested that Kaiser Permanente provide copies of its training scripts, but the insurer has refused, citing proprietary reasons. [Read More]
Blue Cross of Massachusetts sets sights on lower health costs
With an eye on slowing the rate of medical cost increases while rewarding top-performing doctors, Massachusetts' largest health insurer has signed an agreement with a hospital and two physician groups that will provide higher payments to physicians who meet quality and efficiency targets. Blue Cross Blue Shield of Massachusetts signed the Alternative Quality Contract with Mount Auburn Hospital in Cambridge and its affiliated doctors and Hampden County Physician Associates of Springfield. The insurer said the new approach could reduce hospital expenses for care and procedures. The announcement came as Massachusetts Governor Deval Patrick's advisers are looking for ways to control healthcare costs and Blue Cross is in the middle of difficult contract talks with Tufts Medical Center. [Read More]
Managed Care Headlines
Daschle lays out a plan to overhaul healthcare
New York Times - January 9, 2009
Congress set to renew healthcare for children
New York Times - January 13, 2009
Study: Healthcare overhaul needn't break bank
Reuters/Yahoo News - January 9, 2009
Massachusetts governor weighs insurance hearing
Boston Globe - January 13, 2009
Commentary: What Medicaid tells us about government healthcare
Wall Street Journal (subscription required) - January 8, 2009
CMS approves WellCare expansion
Tampa Bay Business Journal - January 14, 2009
WellPoint barred from enrolling new patients in Medicare
Los Angeles Times - January 13, 2009
CIGNA loses Medicare contract
The Tennessean - January 9, 2009
Foundation presents plan to provide universal health coverage in Connecticut
Hartford Courant - January 14, 2009

Webcasts/Audio conferences
January 28: Strategic Marketing Lessons from Other Industries: 5 Innovative Ideas That Work
February 12: Incentive-Based Compensation Plans to Enhance Physician Performance
On Demand: Financial Meltdown: Managing Through The Crisis
On Demand: In-sourcing vs. Outsourcing Disease and Health Management: What's the Right Mix
On Demand: Health Literacy: Four Ways to Create a Successful Program
Listen Up
Should We Expect Major Reforms in 2009?
Joe Paduda, principal at Health Strategy Associates, talks about healthcare reform, the top healthcare issue for the government to tackle, and what he expects will happen to Medicare Advantage this year. [Listen Now]
From HealthLeaders Magazine
Can Individual Insurance Work?

Individual insurance is seen as both a rescuer and a villain. Supporters view the individual market as a critical option for the otherwise uninsured, but foes say such products don't really protect consumers and can be inhumane to those who most badly need insurance. When it comes to the individual coverage market, remember these four truths. [Read More]
   
Guest Commentary
The Next Generation of Care
and Cost Improvements


There's compelling evidence that the next generation of care and cost improvements will come from innovative provider management approaches, writes contributor Sam Muppalla. [Read More]
   
Sponsor Health Plan Insider

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Resources From HCPro

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