HCPro Health Plan Insider - July 15, 2009 | Could a Health Plan Executive Actually Become Governor? Yes View as a Webpage | Subscribe for Free
Could a Health Plan Executive Actually Become Governor? Yes
Les Masterson, Senior Editor-Managed Care

The thought of a health insurer CEO as a viable political candidate would be laughable in other parts of the country (imagine the uproar in a place like California). But, in Massachusetts, Charlie Baker has a real shot—and it goes beyond the current governor's sagging poll ratings and a third-party challenge. [Read More]
  July 15, 2009

 
Editor's Picks
New Health Reform Features Public Option, Individual Mandate, Payment Changes
House Democrats Tuesday unveiled their new 1,018-page Tri-Committee healthcare reform bill that includes a health insurance exchange, public policy option, individual and employer "pay or play" provisions, and a surtax on upper incomes. How much the bill will cost, though, is still not known. Republicans have already come out in opposition to the bill with one leader suggesting federal officials should enroll in the public insurance plan "if it was such a good deal for the American people." [Read More]
Direct Medical Home Offers Healthcare Without Insurers
An insurance-free primary care "direct medical home" that requires patients to pay low monthly fees, but gives them 24/7 access and cheaper healthcare costs has the potential to save hundreds of billions of dollars if it's included in the national healthcare reform model, one advocate says. Norm Wu, CEO of Qliance Medical Management, Inc., which operates one direct medical home that employs nine physicians serving about 2,500 patients in Seattle, says expanding the direct medical home model on a national scale could save patients and employers $300 billion to $500 billion a year largely in the form of lower health insurance premiums. [Read More]
Medicaid Beneficiary Fluctuations are Leading to More Costs
Medicaid's "cumbersome" policies often lead to patients not getting or filling their prescriptions, receiving important diagnostic tests, or managing their chronic disease, which will lead to more costs down the road, according to a new report released by the Association for Community Affiliated Plans. The Medicaid system, which varies by state, requires beneficiaries to show proof more than once a year that they and their children are still eligible for the public program. This leads to many falling off the rolls, which is a cycle that interrupts their continuity of care and jeopardizes their health. The Association for Community Affiliated Plans proposes that Congress pass a "Medicaid Continuous Quality Act," which would establish 12-month continuous eligibility, similar to most private health plans throughout the country. [Read More]
Concern grows that healthcare overhaul won't cut costs
Supporters of President Barack Obama's healthcare reform are quietly raising concerns that the plan would not control healthcare costs, which is what many agree is the number one problem in healthcare. Labor leaders are pushing Obama to more aggressively control costs while business leaders are advocating the administration revamp hospital and provider payments to limit spending. [Read More]
Aetna offers plans to small employers with no co-pay for preventive care
Waiving copays for preventive services has become common in consumer-directed health plans, but Aetna is expanding the idea to more traditional, small employer plans. Aetna introduced new health plans for small employers that will charge no copays for preventive care, such as routine physicians and well-child visits, in hopes of avoiding more costly long-term medical care. In turn, the insurer is also charging higher copays or deductibles on other benefits to offset part of the copay waiver for preventive care. [Read More]
Managed Care Headlines
Congress targets wealthiest earners for health reform funds
Washington Post - July 10, 2009
Massachusetts takes a step back from healthcare for all
Boston Globe - July 15, 2009
Obama Pushes for Health Reform Passage Before Summer Recess
Janice Simmons, for HealthLeaders Media - July 14, 2009
For doctors in Congress, little harmony on healthcare
New York Times - July 13, 2009
Healthcare Costs for Overweight and Obese Patients Grow
Cheryl Clark, for HealthLeaders Media - July 13, 2009
Slump spreads to healthcare as Michigan loses auto jobs
Wall Street Journal - July 13, 2009
Trade group challenges Wal-Mart on healthcare
Wall Street Journal - July 13, 2009

Webcasts/Audio conferences
July 22: Service Line Strategies Workshop 2009: Spine Care
August 18: Advanced Service Line Marketing: New Orthopedics Growth Strategies
August 20: Service Lines Strategies Workshop 2009: Gastroenterology

Listen Up
Streamlining Payments

Robin Bugni, vice president of business innovation and development at Pittsburgh-based health insurer Highmark, Inc., speaks about how to implement real-time claims adjudication and estimation services. [Listen Now]
Health Forum
The Right Prescription to Reduce Costs Through Minimally Invasive Surgeries

By implementing a well designed benefits plan that reflects the value of minimally invasive surgery, health plans can continue to advance patient care and overall outcomes, as well as reduce costs related to health benefits. [Read More]
From HealthLeaders Magazine
Special Needs Plans are Victims of Unintended Consequences

With Democrats in control, Medicare Advantage is facing more scrutiny and payment cuts, and some experts wonder how much longer private payers will stay in the program. But there is a subset of Medicare Advantage that helps the most vulnerable Medicare patients that has been largely ignored during the policy debates. [Read More]
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