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August 6, 2008
A Different Kind of Fraud
Les Masterson, Senior Editor-Managed Care

There is a way employers can reduce healthcare costs without shifting costs to consumers, revamping benefit plans, or implementing health management programs. The down side is the solution could alienate employees. [Read More]

Editor's Picks
State's Medi-Cal program is being hit hard
Things are about to get much worse for the poor and uninsured in California. The state's Medi-Cal program, which provides healthcare to 6.6 million low-income people, will cease payments next week to about 4,700 hospitals, clinics, adult day care centers, and convalescent homes as part of a cost-cutting measure to bridge the state's budget gap. This comes a month after the state implemented a 10% fee cut for the network's doctors, pharmacists, dentists, and other healthcare professionals. That cut is supposed to save the program $610 million annually. In response, a number of doctors and pharmacists are not accepting Medi-Cal patients. [Read More]
Prescription data used to assess consumers
Insurance companies no longer are limited to medical records from physicians' offices when they are deciding whether to cover an individual. Many are also reviewing a person's prescription drug information. This review concerns privacy and consumer advocates who fear that insurers are working outside the oversight of federal health regulators and lawmakers, and consumers might not be aware that insurers are gaining that information. Health insurers and vendors, however, say the practice is a faster, accurate, and less expensive alternative to physician records. [Read More]
Connecticut governor defends Charter Oak plan
There has been plenty of healthcare reform news from a New England state the past week-and it wasn't even from Massachusetts. Connecticut Gov. M. Jodi Rell defended the state's new Charter Oak Health Care Plan following slow enrollment and a news report that the state's Department of Social Services commissioner worried that the state was moving too fast into the program. As of Aug. 1, only 24 people had signed up for the program and the three private insurers who are working on Charter Oak have agreements with fewer than 3,000 primary care providers and two hospitals. [Read More]
Evercare practices reviewed by Massachusetts
The Massachusetts Division of Insurance is investigating Evercare private Medicare plans after complaints from seniors about misleading and abusive sales tactics. Evercare has fired seven independent insurance agents and is investigating 15 others after complaints from seniors. The Centers for Medicare and Medicaid Services is also investigating the company's sale of Special Needs Plans (SNPs) in Massachusetts. Recent Medicare legislation placed greater limitations on sales of SNPs to prevent these kinds of sales tactics. [Read More]
What are your capitation rates?
We are collecting data for the 2009 Capitation Rates & Data survey, and need your help so we can provide the most meaningful data possible. Health plans that offer capitated service are invited to take our 2009 Capitation Survey Questionnaire. Please print the survey, fill it out, and mail it to Les Masterson, HCPro, 200 Hoods Lane, Marblehead, MA 01945. Or fax to Les' attention at 781-639-2982. The first 20 people who respond to the survey will receive a $5 Starbucks Card. We will release the survey results in a publication later this year and I will feature them in an upcoming column.
Managed Care Headlines
Millions with chronic disease get little to no treatment
New York Times, August 5, 2008
New Web site shows NY health plans' performance
The Wall Street Journal (subscription required), August 5, 2008
Health savings accounts haven't caught on in Texas
Dallas Morning News, July 31, 2008
Pennsylvania lawmaker's post to Blue Cross board questioned
Philadelphia Inquirer, July 31, 2008
Cigna second quarter profit jumps 37%
AP/Boston Globe, August 1, 2008
Humana reports profit decline, raises outlook
AP/Philadelphia Inquirer, August 6, 2008
Aetna's second-quarter profit rises 6.4% on boost in membership, higher premium rates
AP/Hartford Courant, July 31, 2008
Survey: Western Pennsylvania has better medical benefits
Pittsburgh Post-Gazette, August 1, 2008

On Demand: Health Literacy: Four Ways to Create a Successful Program
On Demand: Legal and Tax Implications of Incentive Program Designs
On Demand: Value-based insurance design: Alternative to high-deductible plans
Listen Up
Reverse Globalization
Kaveh Safavi, MD, JD, chief medical officer at Thomson Reuters' Center for Healthcare Improvement, discusses how technology might impact global healthcare and the looming physician shortage. [Listen Here]
Consumer Driven Corner
Legal, planning errors can weaken wellness efforts
Employers must beware of crossing the sometimes blurry line between legal and illegal under HIPAA and the Americans with Disabilities Act when offering health and wellness programs. Ignoring that line could threaten the health of their wellness programs. [Read More]
From HealthLeaders Magazine
The Hospital of the Future

HealthLeaders July 2008
Sure, your organization offers sophisticated, compassionate care. But the patients of tomorrow will want much more than that. Here's how some hospitals are creating facilities for a new vision of healthcare. [Read More]
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Resources From HCPro

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