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Health Insurers Go Global
Elyas Bakhtiari, for HealthLeaders Media

When Cigna Corp. CEO David Cordani talked about the “cornerstone” of his company’s growth strategy in a recent Forbes interview, he didn’t single out the individual market or employer-sponsored insurance as the primary drivers of expansion—at least, not in the U.S. It was markets beyond U.S. borders that he described as having outstanding growth opportunities.[Read More]
  July 21, 2010

 
Editor's Picks
Plan Doctor Profiles Inaccurate, Physician Groups Say
The American Medical Association is criticizing how health plans profile physicians, claiming they are are "woefully inaccurate" up to 66% of the time. The AMA points to a RAND study of four health plans in Massachusetts that found one-fourth of physicians would be misclassified under the system of cost ranking used by insurance plans. The organization sent letters to major insurers, demanding "immediate action to improve the accuracy, reliability, and transparency of physician ratings." [Read More]
New Rules: New Health Plans to Provide Free Preventive Care
Under new rules announced by the White House on Wednesday, new private health plans will be required to cover preventive services?and eliminate most cost-sharing requirements?for such procedures as blood pressure, diabetes and cholesterol tests, many cancer screenings, routine vaccinations, prenatal care, and regular wellness visits for infants and children. These plans may no longer charge a patient a copayment, coinsurance, or deductible for these services when they are delivered by a network provider. [Read More]
Oklahoma insurance commissioner challenges new fees on health care plans
State Insurance Commissioner Kim Holland's legal challenge of a 1 percent fee on health care claims approved in the waning days of the legislative session could have a major impact on Medicaid recipients and providers, a spokesman for Gov. Brad Henry said Tuesday. Communications Director Paul Sund said it's too early to say whether Holland's challenge might prompt a budget crisis, "but it would affect Medicaid recipients and providers across the board—nursing homes, doctors, hospitals and their patients. [Read More]
Insurers tout disease management programs, but critics are wary
The Obama administration is drafting regulations that will determine which, if any, disease management programs insurers will be able to count as improving members' health when measuring medical-loss ratio. Consumer advocates argue that only programs whose effectiveness has been scientifically proven should be included. But insurers warn that if the rules are so strict that most of their disease management programs don't qualify, they will be forced to curtail or even drop them. [Read More ]
 
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Managed Care Headlines
UnitedHealth posts 31% profit
The Wall Street Journal,, July 21, 2010
White House now defends insurance mandate as a tax
The New York Times, July 19, 2010
Insurers push plans that limit choices of doctors
The New York Times, July 17, 2010
NC health plan overpaid 33 hospitals, audit finds
The Associated Press, July 21, 2010
 
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Audio Feature
Preventing Missed Revenue Opportunities

Robert Sutton, partner at Chadds Ford, PA-based IMA Consulting, discusses tips for preventing missed revenue opportunities due to third-party payer contractual underpayment. [Sponsored by Emdeon] [Listen Now]
 
 
From HealthLeaders Magazine
New Systems of Care

Geisinger Health System, tucked away in Danville, PA, was already well-known for its ability to innovate in the quality and cost of healthcare before President Barack Obama thrust the health system into the spotlight as a model for care systems. [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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