Top 10 Health Plan Stories of 2011

Margaret Dick Tocknell, for HealthLeaders Media , December 19, 2011

They have appealed to their state departments of insurance to request waivers to delay implementation of the MLR requirement. Meanwhile, brokers who work on commissions contend that the MLR is costing them their livelihood. Congress, or at least a couple of House committees, is itching to jump into the fray on behalf of the brokers.

But here's the rub for legislators: nine million health plan members—make that voters??could be eligible to share rebates worth as much as $1.4 billion.

5.Highmark Purchases Its Own Health System
Contract negotiations between payer and providers can often turn a little ugly with both players threatening to walk away from the contract. The protracted negotiations between Highmark and the University of Pittsburgh Medical Center are so acrimonious that the Blues plan acquired a competing health system, West Penn Allegheny Health System.

Motivated by a combination of spite, business sense and altruism, the acquisition means the Highmark-WPAHS team could challenge the dominance of UPMC in the Pittsburgh-area market. But first the successful Blues plan needs to get the five-hospital West Penn system on firm financial footing. Highmark has already committed $475 million to the task.

There's more to this acquisition than just growing market share. Owning WPAHS makes Highmark the ultimate insider in assessing the cost drivers of the healthcare delivery system. It puts the insurer in the driver's seat in terms of implementing quality and cost control programs across a large, vertically integrated system. Meanwhile, UPMC and Highmark remain at loggerheads and Pennsylvania Gov. Tom Corbett is threatening state intervention to resolve the contract dispute.


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