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January 16, 2008
Four Star Care
Brad Cain, Senior Editor-Managed Care

The business of rating physician care is a tricky one and has resulted in strained relations between health plans and providers who think the ratings rely too much on cost. And New York's attorney general weighed in as well. Now, WellPoint is testing a new physician rating service in partnership with Zagat--the well-known publisher of consumer guides for restaurants, hotels and nightspots--that leaves the job of rating providers to the end consumer of care--the doctor's own patients. While physician organizations are rightfully cautious about another new ranking system coming down the pike, I think this partnership could be good for the industry. [Read More]

Editor's Picks
Aetna Takes the Plunge
Buried in the blizzard of year-end holiday distractions was an announcement from Aetna that could prove, in hindsight, to be one of those watershed events. Just before Christmas (probably the least effective time to put out a press release), the insurance giant said it would pay for Web visit consultations to physicians in more than 30 specialties. Aetna has hooked up with RelayHealth, an online connectivity vendor that was acquired by another giant, McKesson, in June 2006. [Read More]
Lawmakers plan hearings on Missouri governor's insurance program
House Republicans in Missouri have undertaken a comprehensive study that could jeopardize Gov. Matt Blunt's schedule for implementing his "Insure Missouri" program. The program would cover about 54,431 working parents whose incomes fall below the poverty line. The House Special Committee on Health Care Transformation will hold 23 hearings over the next six weeks to scrutinize the governor's program and examine other ways to help the uninsured. [Read More]
Health insurance penalties too low in Massachusetts, panel official says
The penalties for Massachusetts residents who do not obtain health insurance this year have been set too low to encourage people to buy insurance, said a director of the Commonwealth Health Insurance Connector Authority. The authority oversees implementation of the state's health insurance initiative, and members are encouraging harsher penalties. [Read More]
Appeals court allows San Francisco to enforce healthcare law
A federal appeals court has given San Francisco the green light to require employers to help pay for healthcare for uninsured workers and residents. The court also signaled that it is likely to uphold the city's groundbreaking universal coverage law, making it more likely that a proposed state healthcare law will survive any legal challenge. [Read More]
Managed Care Headlines
Petition drive begins for universal healthcare in Michigan
AP/Chicago Tribune, January 16, 2008
Patients caught in Aetna-AMA out-of-network fight
Hartford Courant, January 16, 2008
Florida Medicaid recipients sue state over new plan
Miami Herald, January 16, 2008
Reactions vary on changes to retiree health benefits rule
USA Today, January 16, 2008
CIGNA's PPOs get top rating
Hartford Courant, January 16, 2008
Commission seeks health coverage for more Iowa children
AP/Chicago Tribune, January 16, 2008
Michigan governor supports proposed healthcare amendment
Detroit Free Press, January 16, 2008
NY seeks to steer patients from ERs to family doctors
AP New York, January 16, 2008
Upcoming Events
Consumers Corner

Beyond HSAs: Banks ready for expanded healthcare role: If you think a bank's only role in healthcare is to manage accounts, you are in for a surprise. Banks are poised to play a larger role in healthcare, moving beyond HSA management and into roles usually reserved for carriers and perhaps employers. CDHPs-HSAs in particular-have turned banks into major players in the healthcare financing industry. And that role will only grow, according to several industry observers. [Read More]
Developments in DM
MHS program to eliminate 5 percent savings target
In a development that Medicare Health Support disease management vendors called "encouraging" and "positive," the Centers for Medicare & Medicaid Services said January 7 that participating DM organizations no longer must show 5 percent net savings in their intervention groups to earn their fees. Instead, they just need to show that the medical costs of the intervention groups, including DM fees, are the same or less than the medical costs of the control group. [Read more]
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Resources From HCPro

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