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Bending the Cost Curve Could Also Reduce Physicians' Headaches
Les Masterson, Senior Editor-Managed Care

Administrative simplification is not an exciting topic, but a pilot project could serve as a way to reduce health costs, improve physician/health plan relations, and remove some of the complexity in a healthcare system that so many Americans don't understand. America's Health Insurance Plans, Blue Cross and Blue Shield Association, eight health insurers, and five Ohio physician organizations will begin the pilot project next month that will look to reduce health insurance paperwork and free up physicians' offices from administrative headaches. [Read More]
  October 7, 2009

 
Editor's Picks
Discrimination by insurers likely even with reform, experts say
Though health reform may require insurers to accept all members and not charge higher premiums for the sickest, economists and healthcare analysts are still concerned that health insurers may cherry-pick members. Two examples are being uncooperative on insurance claims, which could chase away the chronically ill, and limiting doctor choices for those with complicated medical conditions, which could cause prospective sick members to not join the health plan, according to critics. [Read More]
Insurers drop some Medicare plans as rules tighten
Health insurers are dropping their private fee for service Medicare Advantage plans because of tougher federal requirements. More than 660,000 seniors will lose that coverage next year. WellCare canceled its PFFS plans for about 110,000 members and UnitedHealth Group is no longer offering PFFS plans. Democrats and President Barack Obama have spoken out about payments to Medicare Advantage private insurers. This drop in PFFS coverage is likely the start of insurers moving away from Medicare Advantage plans if they find it's not worth the lower payments and added regulations. [Read More]
State-run health plans garner support
A new proposal by Sen. Tom Carper would allow state government-run health insurance plans to compete with private insurers. States could act alone or in concert with others to gain more leverage in the marketplace, and would be bound by the same rules established for private companies using the national insurance exchange envisioned by the Senate Finance bill. Any talk of the states getting more involved in the healthcare business should concern health leaders. States are already paying at woeful Medicaid rates. If the states run a public insurance plan, I wouldn't expect higher payment levels. [Read More]
Coventry Health Care to buy Preferred Health Systems
Health insurer Coventry Health Care has agreed to buy health plan Preferred Health Systems of Wichita, KS, which would further the Maryland-based insurer's reach into the Midwest. Under the deal, Coventry would add Preferred Health's roughly 100,000 members to its rolls, giving it more than 1 million members in six Midwestern states. The transaction is scheduled to close in 90 to 120 days. [Read More]
Nurse Leaders Showcased
HealthLeaders Media launched NursingLeaders—its newest weekly e-newsletter—this week. Nurses play a vital role on the senior leadership team of healthcare organizations so it is only fitting that my colleague, Rebecca Hendren, showcases two organizations—Hackensack (NJ) University Medical Center and University Hospital of Brooklyn SUNY Downstate Medical Center—that have demonstrated transformational nursing leadership. [Read More]
 
Managed Care Headlines
As Proposed, Tax on Cadillac Plans May Be A Non-Starter
Cheryl Clark, for HealthLeaders Media, October 6, 2009
Former Clinton Advisor: Healthcare Reform Will Pass
Marianne Aiello, for HealthLeaders Media, October 1, 200
Senate Finance Gives OK to Raise Limits on Employee Healthy Behavior Rewards
Janice Simmons, for HealthLeaders Media, October 1, 2009
Compliance uneven on Massachusetts healthcare law
Boston Globe, October 1, 2009
Blue Cross of Illinois pushing medical homes
Chicago Tribune, October 1, 2009
San Francisco has its own public option
Los Angeles Times, October 5, 2009
Court asks for Obama's stance on Healthy San Francisco
San Francisco Chronicle, October 6, 2009
Swiss healthcare thrives without public option
New York Times, October 1, 2009

Webcasts/Audio conferences
October 29: Flexible Medical Staff Models of the Future
October 22: Marketing to Physicians: Build Relationships to Increase Referrals
On Demand: Service Line Strategies Workshop 2009: Spine Care
 
Listen Up
PBM Improves Medication Compliance

Edmund Pezalla, MD, MPH, national medical director and chief clinical officer at Aetna Pharmacy Management, speaks about how pharmacy benefit managers can receive higher levels of medication adherence. [Sponsored by Emdeon] [Listen Now]
 
Health Forum
Are Healthcare Co-ops the Next Fannie Mae?

Congress attempted to achieve a social objective—higher homeownership rates—on the cheap by using Fannie Mae to acquire mortgages. The subsidy, in the form of an implicit guarantee of Fannie Mae's capital, meant that Fannie did not need to hold the levels of capital required to support the explosion in mortgage lending that resulted. The results are plain for all to see. Fast forward to the healthcare debate: Congress is now proposing to repeat the trick with health insurance cooperatives. [Read More]
 
From HealthLeaders Media
Three Barriers to Effectively Using Information Stored in EHRs

The healthcare industry won't realize the full value of its investment in EHRs until it finds secondary uses for all of the data being captured, according to a new report. [Read More]
 
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Resources From HCPro

Learn how increased collaboration between providers and managed care payers has the potential to reduce costs, improve processes, and enhance patient care.
Discover how to integrate wellness into your DM programs.
Read about practical strategies for maximizing the effectiveness of health and disease management programs.
Learn how to educate and engage members.
 
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