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Mass. Inches Toward ACO Model
Cora Nucci, Senior Online Editor for HealthLeaders Media

Massachusetts, the first state to adopt near-universal healthcare coverage is out in front of healthcare reform once again. This time, the idea is to revamp the system by which physicians and hospitals are paid, from the current fee-for service model to a global payments model. This is a key step toward adoption of the Accountable Care Organization model, which is getting a lot of attention from both providers and payers, even though it is still loosely defined and largely untested.[Read More]
cora nucci
  September 29, 2010

 
Editor's Picks
NAIC Draft on Medical Loss Ratios Open for Comment
Some members of the National Association of Insurance Commissioners want a phased-in approach to limits on health insurance plans that specify how many premium dollars may go toward medical care versus administrative costs and profits. Concerns have been raised on whether the insurers providing coverage to smaller group health markets would be able to meet the medical loss ratios requirements—due in part to higher overhead expenses and fees. [Read More]
DOJ Busts $3 Million Medicare Fraud Scheme
After Hurricanes Katrina, Rita, and Ike, Medicare relaxed procedures to speed healthcare services to people in need by creating the CR Modifier, in which suppliers could be paid by Medicare even if the companies could not comply with normal program documentation requirements because of the hurricanes. Now comes news that three people have pleaded guilty in a scheme to defraud Medicare of $3 million in false claims for wheelchair purchases that were neither damaged by hurricane winds, as claimed, or medically necessary, the Department of Justice says. [Read More]
CDC: Uninsured Rolls Keep Growing
A survey performed by the Centers for Disease Control and Prevention finds that 59.9% of unemployed adults between the ages of 18 and 64, and 22.6% of employed adults, lacked health coverage for at least a part of the past year, and 35.4% and 13.8% respectively were uninsured for more than a year. The data also uncovered an increasing number of insured U.S. residents under age 65 enrolled in high-deductible or consumer-directed health plans. [Read More]
Care Management Solutions Go Mobile
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Intelligence Report: Physician Alignment in an Era of Change
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Managed Care Headlines
Harvard Pilgrim cancels Medicare Advantage plan
The Boston Globe, September 29, 2010
WV set to enter no-bid health insurer contracts
The Charleston Daily Mail, September 29, 2010
Regence BlueShield (WA) drops child-only health coverage
The Seattle Times, September 29, 2010
Sebelius: Health insurers finally get some oversight
The Wall Street Journal, September 28, 2010
Blue Cross, HealthPartners suspend some health plan sales
The Star-Tribune, September 24, 2010
VA to Improve Access to Health Benefits Info
HealthLeaders Media, September 23, 2010
PHOTOS: healers who harm
Newsweek, September 28, 2010
 
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From HealthLeaders Magazine
Strategies for Hospital C-suite Organization

We all know who holds the ultimate power in the C-suite, but what's the ideal balance of power among its other leaders? How do you get your top lieutenants working together as a team rather than as little tyrants lording over their healthcare fiefdoms? [Read More]
 
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Audio Feature
Payment Model Innovation: Sharing the Rewards of a Pay-For-Performance Program

Neal Peyser, Managing Director FTI Healthcare discusses the creation of payment incentives for better collaboration between hospitals and their medical staff. He describes how one facility was able to tap incentive payments from a commercial payer that were based on meeting quality and efficiency metrics, and share them with physicians. [Sponsored by FTI Healthcare] [Listen Now]