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January 23, 2008
One Price Fits All
Brad Cain, Senior Editor-Managed Care

After largely abandoning the capitation model nearly a decade ago in favor of paying providers on a fee-for-service basis, Massachusetts' largest insurer is coming back to the market with an updated plan for paying hospitals and doctors a flat fee for caring for its members...and providers seem receptive to the change. [Read More]

Editor's Picks
Wellness programs may face legal tests
Regulatory guidelines recently issued by the Department of Labor may curtail the ability of employers to motivate workers to kick unhealthy habits. The guidelines close a legal loophole that could have allowed employers to make health insurance more expensive for unhealthy workers than for their colleagues. [Read More]
California healthcare bill faces long hearing, close vote
California Gov. Arnold Schwarzenegger's $14 billion healthcare expansion bill is set to move to the state Senate, where it will face an extended hearing and the likelihood of a close vote in the Health Committee. The legislation would require employers to spend a certain percentage of their payrolls on health coverage for their workers. [Read More]
Blue Cross helps members see cost of healthcare
Blue Cross and Blue Shield of North Carolina announced a plan that makes it possible for members to see the average prices the insurer pays for a wide range of prescription drugs and services online. Members will also be able to access the price breakdown for hundreds of services from annual physicals to heart surgery. It also provides average costs for care that can be provided on an inpatient basis or delivered at an outpatient location. [Read More]
Insurers stop paying for care linked to errors
Aetna Inc., WellPoint Inc. and other big insurers are moving to ban payments for care resulting from serious errors. The companies are following the lead of Medicare, which starting in October 2008 will no longer pay the extra cost of treating bed sores, falls and six other preventable injuries and infections that occur while a patient is in a hospital. Some hospitals are concerned that the strategy could drive up medical costs as hospitals absorb or pass on the expense of introducing the safety and screening procedures needed to help avoid mistakes. [Read More]
Managed Care Headlines
Massachusetts health plan saves towns money
Boston Globe, January 23, 2008
A new program in Rhode Island helps uninsured obtain care
Providence Journal, January 23, 2008
Florida Medicaid recipients sue state over new plan
Miami Herald, January 16, 2008
Universal healthcare plans up against U.S. law
USA Today, January 23, 2008
Will aging boomers lose benefits?
USA Today, January 23, 2008
Maryland insurer to offer quality rewards
Baltimore Sun, January 23, 2008
Oregon Department of Human Services concerned about health plan callers
The Oregonian, January 23, 2008
Upcoming Events
Consumers Corner

2007: Steady growth, enhanced consumerism: It's probably telling that many of the experts we consulted identified something that happened in late 2006--the Tax Relief and Health Care Act of 2006--as the most important CDH development of 2007. But that doesn't mean there was no industry activity: Minneapolis-based UnitedHealthcare purchased Brookfield, WI-based Fiserv's TPA and other healthcare-related businesses, and Philadelphia-based CIGNA recently agreed to acquire Denver-based Great-West Healthcare. [Read More]
Listen Up
Moving Beyond Predictive Modeling
Jim Kerr, vice president of business development at CareGuide, talks about going beyond claims-based predictive modeling to a hybrid model that includes health surveys and effective coaching. Jim speaks about CareGuide's One Care Street program and how to effectively find and engage at-risk people who are willing to improve their health. This is part 1 of a two-part podcast. [Listen here]
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Resources From HCPro

Prove the ROI on your disease management program.
Find how to reach out to cultural populations and address healthcare disparities.
Discover checklists, forms, letters, and clauses to help you with managed care contracts.
Learn why consumer-driven healthcare is like a big hug.
Compare your capitation rates against national averages and help craft workable capitation contracts.
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