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Health Plan Helps Hospitals Achieve Better Grades
Joe Cantlupe, Senior Editor-Managed Care

Hospitals sometimes face issues that CEOs wouldn't like to brag about. When hospitals face these issues, they don't often look to a health plan for help, but that's the case in California. An evolving pilot program in the Golden State involves a health plan, Blue Shield of California; and a hospital system—Adventist Health—as well as the California Health Care Coalition. Under the three-year pilot program, the hospital, providers, and payers are looking to improve healthcare quality and trim costs, and all the while, working together. That's the goal, at least. [Read More]
  March 17, 2010

 
Editor's Picks
Massachusetts Investigating Wide Disparities in Hospital, Provider Reimbursements
Health insurers told a Massachusetts agency examining rising healthcare costs that a statewide trend toward "providing care in more expensive settings" is the primary driver of increasing health costs. Eric H. Schultz, president and CEO of Harvard Pilgrim Health Care, submitted testimony before the Massachusetts Division of Health Care Finance and Policy hearing that stated some physicians and hospitals are paid upward of 300% to 400% higher for some services compared to others. [Read More]
New AMA Database Looks to Help Docs Contract With Insurers
The American Medical Association has launched the National Managed Care Contract, an online database that the physicians' association said will help its members negotiate better contracts with managed care organizations. NMCC is the first managed care contracting resource designed specifically for physicians, and it is expected to provide model contract language that complies with the managed care laws of all 50 states and the District of Columbia, and to cover the range of physician concerns with managed care contracts, the AMA said. The searchable database associated with NMCC provides physicians with access to updated laws and regulations across the nation. [Read More]
Employers Are Miffed that Workers Are Not Changing Unhealthy Habits
Employers are frustrated that too many of their workers are failing to change their unhealthy habits and take advantage of health and wellness programs that include financial incentives, according to a survey by Towers Watson and the National Business Group on Health. As a result, some employers are "accelerating" efforts to find ways to further motivate employees and also tighten their requirements for participation in certain healthcare plans, says Ted Nussbaum, senior consultant for Towers Watson, a global professional services company, and co-author of the survey. [Read More]
Connecticut AG Charges Antitrust Practices in Health Insurance Industry
Connecticut Attorney General Richard Blumenthal announced that his office has uncovered a potentially anticompetitive practice by health insurance companies that could raise healthcare costs and lower competition. In a letter to HHS Secretary Kathleen Sebelius, Blumenthal called for an investigation of these practices at the national level. Blumenthal said his office has been conducting an antitrust investigation of Anthem Blue Cross and Blue Shield of Connecticut, which is owned by WellPoint, Inc., and has found contractual Anthem clauses—commonly referred to as Most Favored Nation clauses—requiring hospitals and other providers to allow Anthem to pay the lowest reimbursement rates in the industry. [Read More]
Poor Air Quality Leads to More Hospital Costs, Says RAND
California's long-standing and severe smog problems cause many avoidable hospitalizations that added $193 million in hospital costs between 2005 and 2007, according to a RAND Corp. report. The researchers broke the cost of that dirty air down by the number of patients treated at sample hospitals in certain high air pollution counties in the state, and analyzed avoidable spending for treatment of pollution-related illnesses for each county. Similar to tobacco litigation settlements that bring millions of subsidies to states and counties, the authors suggest that polluters rather than health plans, employers, patients, and government health payers, might be asked to pay to treat patients harmed by those air contaminants. [Read More]
Managed Care Headlines
Killingsworth Resigns from BCBS of MA
Les Masterson, for HealthLeaders Media, March 15, 2010
Health bill gives insurers a younger market
Wall Street Journal, March 16, 2010
About 1 in 4 in California lack health insurance, a UCLA study finds
Los Angeles Times, March 16, 2010
Anthem Blue Cross should reimburse California man for transplant, jury says
Los Angeles Times, March 16, 2010
Project to get transplant organs from ER patients raises ethics questions
Washington Post, March 15, 2010
Blue Cross and Blue Shield of Minnesota is sued over disclosing woman's medical records
Minneapolis Star Tribune, March 15, 2010
Millions spent to sway Democrats on healthcare
New York Times, March 15, 2010
Ranks of uninsured in Indiana, U.S. growing fastest in middle class
Indianapolis Star, March 17, 2010
Big insurance rate increase for Pennsylvania poor
New York Times, March 17, 2010

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Using Claims Transparency to Reduce Waste

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Voice Personality is a Powerful Lever to Motivate Health Behavior

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From HealthLeaders Magazine
Avoiding the $10K Deductible

Health insurance deductibles increase every year as employers and health plans look to pass costs to members and create better healthcare consumers. The average health plan deductible is about $5,000, as employers and health plans have expanded the deductible concept to PPOs and HMOs. If we follow this path, deductibles could balloon to $10,000 within the decade. That's one path. Another is happening in Oregon. [Read More]
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