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Three Steps to Lower Insurer Overhead Costs
Les Masterson, Senior Editor-Managed Care

Medical loss ratio restrictions may not be the best way to reduce health costs, but federal and state lawmakers are increasingly turning to legislating MLR as a way to contain expenses. Forcing insurers to maintain a certain spending percentage on medical care is an easy win and on the surface sounds like a fair plan. However, it's not that simple. Nevertheless, that's the world health insurers are living in and the recently approved health reform package will require some plans to spend 85% directly on patient care. This will have many insurers scrambling to find ways to reduce overhead costs. [Read More]
  April 14, 2010

 
Editor's Picks
CMS Bans Aetna From Enrolling New Medicare Beneficiaries
CMS issued an immediate sanction notice to Aetna after the insurer "continued to improperly administer the Medicare drug benefit in the plan's national standalone prescription drug plan and its 25 Medicare Advantage prescription drug contracts," according to CMS. The immediate sanction prevents Aetna from marketing to and enrolling new beneficiaries effective April 21. The sanction will remain in place until Aetna "demonstrates to CMS that it has corrected its deficiencies and they are not likely to recur." The sanction will not affect the 1 million Medicare Advantage and Part D members enrolled in Aetna plans now, but expect CMS to make an example of the huge insurer if it does not fix the issues immediately. [Read More]
Health insurers looking to capitalize on new Target Field in Minnesota
Peanuts, hot dogs, baseball, and health insurance. Now, that's the American way. Blue Cross and Blue Shield of Minnesota will utilize the Minnesota Twins' new Target Field to spread its brand name. In addition to signage, which has become commonplace in many stadiums and arenas, Blue Cross will also brand first-aid stations and the Twins will play Blue Cross-sponsored video stories about people who are working to improve their health. With millions of newly insured coming onboard and the greater consumerism movement in health insurance, health insurers will increasingly look for these opportunities to spread their message. [Read More]
Judge blocks Massachusetts insurers on rates
A Superior Court judge rejected six Massachusetts health insurers' premium increase requests to small businesses and individuals. The insurers are appealing the state's rejection of 235 proposed rate increases with the Division of Insurance. Governor Deval Patrick, who implemented regulations that led to the insurers' premium increase rejections, is in a tough election battle with former Harvard Pilgrim CEO Charlie Baker. Patrick will surely try to paint Baker as an unfeeling health insurance executive and use the proposed increases during the campaign. Though the judge sided against the insurers, Jay McQuaide, vice president at Blue Cross and Blue Shield of Massachusetts, is still hopeful that the companies will ultimately be allowed to increase rates. [Read More]
States fret over health insurance scams
This is not surprising. Wherever you find opportunity and new money, you can always expect scammers to follow. State regulators are cracking down on companies allegedly offering bogus health plans. One official called the combination of high unemployment, expensive health premiums, and millions of uninsured "an ideal breeding ground for scams." I would add that the health reform debate is also sparking more Americans to look for health insurance and unsuspecting people are being taken by scam artists. State and federal governments are on the lookout, but legitimate health insurers should also be aware of the problem. [Read More]
Looking for Strong Leadership Teams
The deadline is approaching to enter the seventh annual Top Leadership Teams in Healthcare Awards—a program that celebrates stories of great healthcare leadership in hospitals, health plans, and medical group practices. There are five categories: large hospitals and health systems (500 or more licensed beds); community and mid-sized hospitals (100 to 499 licensed beds); small hospitals (fewer than 100 licensed beds); health plans (state, regional, and national); and medical group practices (physician-owned, single- or multi-specialty groups employing 25 or more physicians). Previous winners in the health plan category include Independent Health in Williamsville, NY, and Harvard Pilgrim in Boston. [Learn More]
Managed Care Headlines
BCBS of TN Hard Drive Theft Now Threatens 1 Million Customers
John Commins, for HealthLeaders Media, April 9, 2010
Blue Cross-Blue Shield CEO says insurers, Massachusetts must cooperate
Boston Globe, April 13, 2010
Could health overhaul incentives hurt some?
New York Times, April 13, 2010
Thousands of Anthem Blue Cross customers await decision on rate hikes
Los Angeles Times, April 12, 2010
Georgia insurance commissioner says no to high-risk insurance pool for state
New York Times, April 13, 2010
NY AG: Health Insurers Offering Expensive, Inferior Coverage to College Students
John Commins, for HealthLeaders Media, April 8, 2010

Webcasts/Audio conferences
April 22: Neuroscience Service Lines Strategies
May 13: Integrated Compensation Plans to Enhance Physician Performance
May 19: Five Proven Steps to Improve Patient Satisfaction Scores
June 2: Seamless Systems of Care: Better Alignment, Coordination, and Outcomes

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Audio Feature
The State of HSAs

Martin Trussell, senior vice president of business development at First Horizon Msaver, a leading provider of health savings accounts, talks about the state of HSAs and how health reform will affect them. [Sponsored by Emdeon] [Listen Now]
Audio Feature
Strategies for Reducing Drug Spending

Find out how Virginia Commonwealth University Health System saved $2.5 million annually from their outpatient drug spending by working with a nonprofit group to qualify more patients for their appropriate prescription benefits and reducing their drug purchase costs through bulk purchasing. [Sponsored by Emdeon] [Listen Now]
Health Plan Forum
Voice Personality is a Powerful Lever to Motivate Health Behavior

In healthcare, individuals are educated and supported in the decisions they make about their health through communications. This article highlights a recent study of the impact of voice in healthcare communications and how individuals perceive voice as it relates to health messaging. [Read Now]
From HealthLeaders Magazine
Putting the Consumer in Charge

The relationship between insurers and their members has been traditionally cool—at best. On the positive side, consumers see health insurers as the faceless entity that pays for their care and, more negatively, the companies that reject paying for care. The consumerism movement in benefit design has shifted more costs and decision-making to individuals. By 2020, members will have even greater responsibility for their healthcare. Members will need to become better healthcare consumers. Health insurers see the transformation coming, and leaders are preparing. [Read More]
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