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January 30, 2008
Healthcare Reform Terminated?
Brad Cain, Senior Editor-Managed Care

California's yearlong flirtation with broad-scale healthcare reform ended earlier this week with only one member of a key state panel voting in favor of the proposal. Supporters of the reform plan negotiated by Gov. Arnold Schwarzenegger and the Democratic leadership in the state Assembly remained positive and said the fight is far from over, but I'm not so sure I share their optimism. [Read More]

Editor's Picks
More hitting cost limit on health benefits
Small but growing numbers of American families beset by major medical problems are learning that having health insurance is sometimes not enough. Those with costly chronic illnesses can easily rack up medical bills that blow through the lifetime benefits cap of $1 million or more that is a standard part of many insurance policies. That has left some very sick people facing healthcare tabs of hundreds of thousands of dollars or more. [Read More]
Blue Cross Blue Shield Association proposes fix for uninsured Americans
The Blue Cross and Blue Shield Association has presented a proposal to reduce the number of Americans without medical coverage, and is calling it a blueprint for U.S. policymakers. The plan would combine tax credits to encourage people to buy coverage with ideas to improve the quality of healthcare. The association has also proposed helping states find and enroll people who are eligible for existing public health insurance programs but are not using them. [Read More]
Employers put health coverage in workers' hands
As health insurance costs continue to rise, some employers are adopting a controversial new approach that ends group coverage and gives employees $50 to $200 or so a month to help them buy their own. The shift is touted as a lower-cost way for employers to offer workers health coverage, while making smaller and more predictable financial contributions toward that coverage. If broadly adopted, the new model would represent a fundamental shift in health coverage. [Read More]
Copays contribute to drop in preventive care
A study has found that when women in Medicare managed-care plans were asked to contribute a small copay, 8 percent of the women decided to forgo mammograms altogether. Insurance plans are increasingly instituting cost sharing in the form of copays with the hope that consumers will consider cost before getting healthcare services. Although the goal is that people will reconsider potentially unnecessary procedures or medicines but not forgo essential services, the study illustrates it does not always work out that way. [Read More]
New Mexico health plan debuts to mixed reviews
New Mexico Gov. Bill Richardson's health coverage plan has debuted before a legislative committee to mixed reviews. Some business leaders, healthcare companies and providers have praised the plan, calling it a big step toward reforming a system under which 400,000 New Mexicans remain uninsured. Critics, however, say that the plan goes too far--or not far enough. [Read More]
Managed Care Headlines
Report criticizes Kaiser for lack of action
Los Angeles Times, January 30, 2008
Diabetes' health toll hits $174 billion annually
HealthDay/Washington Post, January 30, 2008
TennCare action worries disabled
The Tennessean, January 30, 2008
Tenet hospitals, Blue Cross reach major managed-care contract
East Bay Business Times, January 30, 2008
Cost of health initiative up $400 million in Massachusetts
Boston Globe, January 30, 2008
Doctors paid to prescribe generic pills
Wall Street Journal (subscription required), January 30, 2008
Dispute puts some Humana patients in a bind
Louisville Courier-Journal, January 30, 2008
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Developments in DM

Blue Cross/Blue Shield promotes medical home demonstrations: The concept of a medical home is taking shape in several demonstration projects that include elderly patients with multiple chronic conditions, as well as fewer sick patients who stand to gain from wellness and DM interventions that are led by the patient's physician. Some of the largest insurers in the country are leading the way in this effort. Blue Cross and Blue Shield Association (BCBS), Chicago, and 27 participating BCBS companies have joined with four major U.S. physician groups, national employers, and consumer groups to examine the medical home model of care in primary care demonstration projects around the country. [Read More]
Listen Up
Moving Beyond Predictive Modeling Part 2
Jim Kerr, vice president of business development at CareGuide, talks about his company's One Care Street, which is a survey-based predictive model, and how the program is impacting health and costs. He also gives his thoughts about the future of predictive modeling in this podcast, which is the second of a two-part series. [Listen here]
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