HealthLeadersMedia.com - Health Plan News & Analysis

UnitedHealth will tie doctors' payments to quality of care

Fri, 10 Feb 2012 12:07:00 GMT

UnitedHealth Group Inc., the largest U.S. health insurer by sales, will pay doctors based on the quality of their care in a cost-cutting effort that also benefits the company's consulting business. UnitedHealth expects to save twice as much as it would spend on incentive payments for doctors because patients will be healthier, according to company documents

For-profit cancer center to make its case to NH lawmakers

Fri, 10 Feb 2012 12:01:00 GMT

Cancer Treatment Centers of America is eyeing a spot in New Hampshire. The for profit chain wants to build a hospital in the Northeast. CTCA successfully lobbied Georgia to change its regulations so a specialty hospital could be built in that state. The company is hoping lawmakers in New Hampshire will make similar changes.

Opinion: End may be near for hands-off regulation of healthcare insurance in TX

Fri, 10 Feb 2012 11:57:00 GMT

Like it or not, healthcare reform is coming to Texas, and it's dragging health insurance into the modern age. In this state, lawmakers and businesses embrace the mantra of free markets and low regulation. Regulators don't have the authority to reject increases in health insurance premiums. They didn't even bother with a rate review unless an increase topped 50 percent a year—a threshold that speaks volumes about the role of limited government here.

Hospital exec charged in $116M Medicare scam

Fri, 10 Feb 2012 11:55:00 GMT

An executive of Riverside General Hospital was arrested and charged Wednesday in a $116 million Medicare scheme involving kickbacks to patient recruiters and the owners of homes for the elderly and disabled in exchange for steering residents to Riverside's mental health clinics.

The future of mHealth: Healthcare apps to lower insurance costs

Fri, 10 Feb 2012 11:41:00 GMT

Several large U.S. health insurance companies, including Aetna, WellPoint and UnitedHealth Group, currently offer mobile apps that help members find network providers and perform other simple functions. On the surface, these apps strengthen connections with members and providers. However, the mobile health revolution holds deeper implications for the insurance industry, which plans to enhance future mobile offerings to more directly impact patient health, according to the American Medical Association.

New rules call for simpler-to-understand group health insurance benefits, costs

Fri, 10 Feb 2012 10:03:00 GMT

Starting Sept. 23, group health insurance policies in America must provide consumers and employers with a simple, easy-to-understand summary of benefits and costs. The new rules, announced Thursday, aim to eliminate confusing and technical language in policies "the size of a small phone book," said Marilyn Tavenner, acting administrator of the Centers for Medicare and Medicaid, in announcing the changes Thursday.

UnitedHealth revamps fees

Thu, 09 Feb 2012 12:03:00 GMT

U.S. insurer UnitedHealth Group Inc will revise the way it pays doctors and hospitals, a move which it expects will bring down expenses, a Wall Street Journal report said, citing documents sent by the company to employer clients.

NH hospital officials blast for-profit cancer center bill

Thu, 09 Feb 2012 11:54:00 GMT

Representatives of New Hampshire's major hospitals fought a proposal that could pave the way for a for-profit cancer facility to come to the state at a hearing Tuesday that was notable for the absence of the company that was the impetus for the legislation: Cancer Treatment Centers of America (CTCA). The bill would create a special "destination cancer hospital" classification, which would be exempt from the state's Certification of Need review process for new hospitals, as well as the Medicaid Enhancement Tax on the grounds that it wouldn't accept Medicaid patients.

Expect more insurance drama in Pittsburgh

Thu, 09 Feb 2012 11:44:00 GMT

If you think Pittsburgh's health insurance landscape has changed dramatically in the last year, you ain't seen nothing yet, according to six of the region's top insurance executives. Expect more friction between physicians and health plans as insurers try to wring what they call unnecessary procedures, scans and surgeries out of the system.

Commonwealth Fund to Study Access to Healthcare

Wed, 08 Feb 2012 18:00:00 GMT

An effort to track low- and moderate-income adults to see how they fare under the Affordable Care Act may offer glimpses as to whether it is accomplishing its goals, or whether it's just another behemoth government program.

14 Hospitals reach $12M false claims accord

Wed, 08 Feb 2012 12:11:00 GMT

Fourteen hospitals in New York and six other states agreed to pay more than $12 million in total to settle allegations that they submitted false claims to Medicare, the U.S. Justice Department said. Four hospitals affiliated with Adventist Health System/Sunbelt Inc. in Florida will pay the largest sum, $3.9 million, according to an e-mailed statement by the Justice Department. Plainview Hospital in Plainview, New York, will pay $2.3 million, the largest single hospital payment, the agency said.

Opinion: Medicare payment formula must be repealed

Wed, 08 Feb 2012 11:59:00 GMT

Unless Congress acts, access to health care for seniors and military families will be placed in jeopardy. On March 1, physicians who treat patients with Medicare and TRICARE (the health care program for service members, retirees and their families) face an across-the-board cut of 27 percent due to a flawed formula created by Congress, writes AMA president Peter W. Carmel, MD.

WA state has new plan for ER limits; doctors critical

Wed, 08 Feb 2012 11:53:00 GMT

Lawmakers last year called for reducing poor patients' use of emergency rooms to save Medicaid $72 million, but state officials' first try at a three-visit limit on "nonemergency" visits to the ER was criticized by doctors and hospitals and struck down by a judge over procedural flaws. The state now has a new plan with a stricter limit: Medicaid will cover zero ER visits if treatment in an emergency room is "not medically necessary" for a health condition.

Essential Health Benefits Bulletin Draws Fire

Tue, 07 Feb 2012 12:31:00 GMT

A federal move to put states in charge of decisions regarding essential health benefits for health insurance exchanges is drawing generally negative public reaction.

$1.5M New West deal before insurance commissioner

Tue, 07 Feb 2012 12:15:00 GMT

State regulators are examining a $1.5 million proposal by an Oregon insurer to take over a portion of Montana's third-largest health insurance company as part of a government anti-trust settlement. Commissioner of Securities and Insurance Monica Lindeen has scheduled a hearing Tuesday on the proposal by PacificSource Health Plans to buy New West Health Service's commercial business. The hearing will examine whether the deal is fair and protects the estimated 9,000 New West policyholders who will be affected, said Lindeen spokesman Lucas Hamilton. The hearing will include a public comment period.

VT would allow ’bronze plan’ to encourage health

Tue, 07 Feb 2012 12:10:00 GMT

Vermont Gov. Peter Shumlin and legislative leaders said Monday they wanted to make it possible for more of the state's small businesses to offer lower premium health insurance plans sometimes known as "bronze plans" until the state can implement its single payer health care system. Speaking Monday in Montpelier, Shumlin and leaders from the House and Senate, all Democrats, said they would also allow businesses with more than 50 employees to remain outside the federally-mandated health care exchange until 2016. "We feel strongly that the exchange is not the answer to all Vermont's health care problems," Shumlin said at a news conference in the Montpelier Statehouse.

Medicaid changes challenge TX hospitals to do things differently

Tue, 07 Feb 2012 12:09:00 GMT

The goal is lofty: improve and expand health care for millions of Texans. But with billions of dollars at stake and the new project under way before the rules are even written, decisions made over the next few months are causing anxiety in many Harris County hospitals. The new rules—part of a complicated, first-of-its-kind project approved by the federal government—will determine who gets paid for providing charity care, and how much. Hospitals that historically received the most government reimbursement for charity care are not guaranteed to prosper under the new rules.

Questions raised about proposal for PA's insurance exchange

Tue, 07 Feb 2012 11:34:00 GMT

Advocates for health insurance reform are taking a dim view of a draft proposal for the state's health insurance exchange, saying it could keep the playing field tilted in favor of insurance companies and against consumers. Speaking at a conference call Friday, Antoinette Kraus, project director of Pennsylvania Health Access Network, a coalition of organizations supporting consumer-friendly health reform, said the draft proposal distributed by the state Insurance Department, if enacted, would not change the status quo. "They're using this as an opportunity to line the pockets of big business," said Kraus.

Boston's BIDMC Medicare billing examined

Mon, 06 Feb 2012 12:13:00 GMT

Federal investigators have subpoenaed six years of records from Beth Israel Deaconess Medical Center as part of an investigation into whether the hospital overbilled Medicare by admitting patients for short stays who could have been treated less expensively as outpatients. Beth Israel Deaconess received a subpoena from the office of the inspector general of the US Department of Health and Human Services and the US Department of Justice, in 2010, the hospital disclosed in financial statements over the last six months.

Insurance lags on wound care

Mon, 06 Feb 2012 11:59:00 GMT

Medical device firms across Minnesota have invested millions to develop products to heal open wounds, a $1.8 billion market that is expected to grow as the population ages and the number of people with type 2 diabetes climbs. But many of these companies are struggling to get their treatments to the masses because insurance companies often refuse to pay for their products.