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Consumerism Could Be Private
Health Insurers' Waterloo

Les Masterson, Senior Editor-Managed Care

It's been six years since health insurers started offering health reimbursement arrangements, but the question remains: Are consumer-directed plans merely a way for employers and health plans to shift more costs onto members? [Read More]
  February 11, 2009

 
Editor's Picks
HealthLeaders Survey Results Show Disconnect
HealthLeaders Media's Industry Survey is an annual glimpse into the healthcare industry across multiple areas. This year, we included health plans/managed care in the survey, and what we found was fascinating. We created a Web page that highlights the findings for each of our surveys, which allows readers to see what thought leaders from various segments of healthcare think. The most interesting findings for me pertained to comparing physicians with health plans. As would be expected, health plans and physicians don't agree on much, including pay-for-performance programs, reimbursement, and how to improve payer/physician relations. Check it out for yourself. [Read More]
AMA, medical associations suing insurers over payments
The American Medical Association and medical associations in several states are suing health insurers Aetna and CIGNA for reportedly using rigged data to under-reimburse physicians. The lawsuits claim that the insurers have also forced patients to pay excessive costs for more than a decade. The medical associations are looking to reform the payment system and seek relief for physicians who may have been harmed by the payment system. In response, America's Health Insurance Plans said all stakeholders should focus on ways to control costs—not provide a "blank check" for providers to charge rates that are exponentially higher than Medicare payments. [Read More]
Obama signs SCHIP expansion, lifts restrictions
Do you want proof there is a new sheriff in town? President Barack Obama signed a bill last week that expanded the State Children's Health Insurance Program (SCHIP) by roughly $35 billion over the next five years and lifted restrictions that will allow states to enroll more children from middle-class families into SCHIP. Inching closer to his campaign promise of insuring every child, Obama broadened SCHIP's scope, which he said will provide coverage for tens of thousands of children. The measure was similar to two bills vetoed by former President George W. Bush. But anyone who thinks a new president will end partisanship should note that dozens of Republicans voted against the expansion, which could be a harbinger of what to expect for the upcoming healthcare reform debate.
WellCare leaving Florida's Medicaid reform program
In a move that could wound Florida's Medicare managed care program, WellCare is leaving the program because the insurer said government-set reimbursement rates are too low. WellCare, which serves 78,000 Medicaid managed care clients and is the largest Medicaid insurer in Florida, said state budget cuts made the program economically unfeasible. The health insurer will continue to participate in the state's main Medicaid program. [Read More]
UnitedHealth and IBM test medical home
With the backing of IBM, one of the state's biggest employers, UnitedHealth Group is testing the medical home model in Arizona. The medical home, which places more control and coordination in the hands of providers, is seen by some as the future of healthcare with more emphasis on quality and paying doctors for coordinating patient care. IBM has been a vocal proponent of the concept. The insurer tried a similar experiment in Florida, but doctors were not interested because of the added workload coupled with inadequate payments for their services. [Read More]
Anthem Blue Cross is taking its lumps
Anthem Blue Cross is not having a good day. California's largest for-profit health insurer agreed to pay $1 million, provide new coverage to 2,330 former members who were dropped after receiving expensive medical care, and reimburse those members for their care. That figure alone could reach $14 million. In exchange, the state's Department of Insurance has agreed to drop its investigation into whether the company broke laws when it rescinded member PPO policies and follows a $10 million fine paid to the state Department of Managed Care for rescinding 1,770 members in HMO plans. But wait, there's more: Anthem is also taking heat for raising premiums for about 80% of its 800,000 individual policyholders in California. Consumers are bashing the rate increases, some reaching more than 30%, but the insurer blamed the higher premiums on the costs of medical services, new prescription drugs, and technological advancements. [Read More]
Managed Care Headlines
Analysts say number of uninsured Americans to grow
AP/Yahoo News - February 11, 2009
Medicare Advantage prices rise as overhaul plan nears
Bloomberg News/Philadelphia Inquirer - February 5, 2009
Cigna's stock rises 19% despite quarterly loss
Wall Street Journal - February 6, 2009
New York AG: Two more insurers agreed to fund database
CNNMoney.com - February 10, 2009
Insurance settlements may benefit patients
Wall Street Journal - February 5, 2009
Ban on using gender in health insurance rates weighed in Connecticut
Hartford Courant - February 11, 2009
Cigna Web tool tells cost of care upfront
Wall Street Journal - February 11, 2009
North Carolina health plan needs $1.2 billion
Raleigh News & Observer - February 4, 2009
MVP Health Care settles its dispute on payments
New York Times - February 5, 2009
Survey: Texas doctors say insurers' paperwork hurts patient care
Dallas Morning News - February 5, 2009

Webcasts/Audio conferences
February 12: Incentive-Based Compensation Plans to Enhance Physician Performance
February 20: ED Overhaul 2009: Five Improvements to Make Today
February 24: Form 990H: Act Now to Protect Your Reputation
From HealthLeaders Media
Are you the Boss from Hell?
A new CareerBuilder.com survey of 8,038 workers from a variety of industries shows that 43% say they've quit a job at some point in their lives because of bad bosses. [Read More]
From HealthLeaders Magazine
The CDHP Trickle

A lack of consumer understanding has contributed to the glacial growth of consumer-driven plans. Can better information from health plans help CDHPs take hold? [Read More]
Sponsor Health Plan Insider

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