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Health Insurance Cost Tipping Point Inches Closer
Les Masterson, Senior Editor-Managed Care

Though businesses are transferring more health costs onto employees, health insurers and employers have to be careful not to pass too many costs onto the consumer. The last things that health insurers want are people dropping their coverage or needing to file for bankruptcy because an insurer's plan is being used as a way to protect the employer and insurer from rising health costs. [Read More]
  October 14, 2009

 
Editor's Picks
Three Areas of Debate When Reform Bill Reaches Senate Floor
The Senate Finance Committee's vote on Tuesday was a major health reform milestone, but there is plenty of work to come. When the bill reaches the Senate floor, possibly as early as the end of this month, Senators will embark on a historical, heated debate. Three possible areas of contention will involve the public insurance option, tort reform, and Medicaid. [Read More]
MGMA Survey Ranks Medicare as Top Payer
Medical groups love Medicare Part B because of its predictability and the clearness of its rules, but groups are not so happy with Medicare's credentialing process, according to a new Medical Group Management Association report. More than 1,700 MGMA members were asked to rate their satisfaction with payers on issues related to responsiveness, transparency, prompt payment, credentialing, and overall satisfaction with administrative functions. Medicare topped the list with an average ranking of 3.59 on a five-point scale. Aetna came in second at 3.14. This shows that medical groups are satisfied with lower payments as long as reimbursements and payment processes are predictable. [Read More]
Democrats call insurance industry report flawed
America's Health Insurance Plans' report this week that health premiums would increase 18% more under a Senate Finance Committee plan than they could without health reform has been met with opposition from the Obama administration and Congressional Democrats. Health insurance foes questioned the timing of the report and White House officials said AHIP ignored features of the bill that would lower health costs for consumers. The nonpartisan Congressional Budget Office, on the other hand, said it cannot calculate the net effect of the Senate Finance bill because there are too many uncertain factors. [Read More]
Health insurers emerge as Obama's top foe in reform effort
For months, President Barack Obama and Democrats have bashed health insurers—with Speaker of the House Nancy Pelosi even referring to insurance companies as the "villains" in healthcare. American's Health Insurance Plans has not fought back, but that changed Monday with the report that suggested the Senate Finance Committee bill would lead to higher premiums. In turn, Democrats and public insurance option supporters have turned up the heat on health insurers with some pundits believing the report will galvanize public opinion for a public option. [Read More]
House eyes windfall tax on insurers for health bill
Health insurers may have to soon hold onto their wallets. Congress is considering a tax on health insurers' windfall profits as a way to pay for health reform. This idea comes after a tax on high-end Cadillac health plans appears dead. The Senate Finance Committee's windfall-profit tax proposal would bring in $6 billion annually, but it's unknown how much the House idea would gain. [Read More]
What do Health Plan Leaders Think?
The 2010 edition of the HealthLeaders Media Industry Survey for Health Plan Leaders is now open online. Included this year are new questions that seek your thoughts on the HIT stimulus package and healthcare reform efforts, among others. Plus, we build on key benchmark questions from last year, checking on your top priorities and your assessment of key population health initiatives. This comprehensive survey should take about 14 minutes to complete. Be sure to provide contact information and we'll enter your name in a drawing for a $1,000 gift card.
 
Managed Care Headlines
Insurance mandates draw flak from both sides
Wall Street Journal, October 12, 2009
Healthcare tug of war puts patients in the middle
Washington Post, October 9, 2009
Employer-Backed Medical Benefits Will Average $10K Next Year
John Commins, for HealthLeaders Media, October 8, 2009
Healthcare bill would not raise deficit, report says
Washington Post, October 8, 2009
Aetna Ends Two Medicare Advantage Programs In Connecticut
Hartford Courant, October 13, 2009
Minneapolis-area healthcare rivals to work together
Minneapolis Star Tribune, October 14, 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]
 
From HealthLeaders Media
Reform Could Mean Lower Medicare Costs

Enacting national healthcare reform legislation to extend coverage to the uninsured could prove to be a boon to one federal program: Medicare. [Read More]
 
From HealthLeaders Magazine
Disease Management's Struggle to Remain Relevant

Disease management, once trumpeted as a way to control costs and improve patient outcomes, has been the subject of a number of recent reports questioning whether it actually reduces health costs. There are four ways disease management can reclaim a vital role in healthcare. [Read More]
 
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Resources From HCPro

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