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The Challenge of Measuring Healthcare Value
Elyas Bakhtiari, for HealthLeaders Media

Last week the nation’s largest health insurers received a letter from the American Medical Association and 46 state medical societies that sharply criticized the accuracy and reliability of the cost-profiling mechanisms that many payers use to rate and tier physicians.[Read More]
  July 28, 2010

 
Editor's Picks
White House Unveils Consumer Rules to Appeal Health Plan Decisions
The Obama Administration announced on Thursday new regulations that would permit consumers to appeal decisions?such as claims denials and rescissions—made by their health plans or insurance companies. The new regulations—issued by the Departments of Health and Human Services (HHS), Labor, and Treasury—include the right for consumers to appeal decisions made by a health plan through the plan's internal process or through an outside, independent decision-maker. This will apply to any state where a patient lives or whatever type of health coverage the consumer has. [Read More]
Watchdog says nonprofit insurers may be holding surpluses
Nonprofit health insurers may be setting aside "unnecessarily large" surpluses while raising premiums, according to a consumer rights group. For example, seven of 10 Blue Cross Blue Shield affiliates examined had amassed surpluses more than three times the level regulators deemed necessary for them to remain solvent. The insurers claim that because nonprofit plans cannot raise additional funds from capital markets, the surpluses are needed for growth. [Read More]
AHRQ Expands Data on Health Insurance, Quality
The Agency for Healthcare Research and Quality's annual release of state-by-state quality data now has data on health insurance, including healthcare quality categorized by private insurance, Medicare, Medicaid and the uninsured, AHRQ announced Tuesday. The health insurance section allows users to compare payer-specific quality rates as well as differences among payers. [Read More]
Health Plan Rate Filings to Be Emailed to California Enrollees
In another effort to convince insurance companies not to impose premium increases lightly, Californians may now be notified by e-mail whenever their plan proposes a commercial plan rate hike. "We want as many people as possible scouring these rate filings to ensure they are mistake-free," state Insurance Commissioner Steve Poizner said in a statement. Health plan premium increases do not require regulatory approval in California although several bills have been introduced to change that law. [Read More ]
 
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Managed Care Headlines
UHG's Ingenix buys health data firm Picis
Minneapolis/St. Paul Business Journal,, July 22, 2010
For Insurers, Fight Is Now Over Details
The New York Times, July 14, 2010
Seniors Unclear on Healthcare Reform Law
HealthLeaders Media, July 27, 2010
CMS Releases SNF PPS Rates for Fiscal Year 2011
HealthLeaders Media, July 27, 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
Nursing's Growing Role

The new focus is on nurse-led care delivery systems and harnessing the economic power of nursing. [Read More]
 
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Learn how increased collaboration between providers and managed care payers has the potential to reduce costs, improve processes, and enhance patient care.
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