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August 13, 2008
Americans Want a Home
Les Masterson, Senior Editor-Managed Care

Many Americans are pushing for a new healthcare system, as most agree the existing structure is flawed. What consumers actually want is care coordination. They might not know the term "medical home," but Americans like the idea of their doctor coordinating their care. [Read More]

Editor's Picks
Healthcare costs seen rising 10% in 2009
A survey of health insurers shows healthcare costs will rise slightly more than 10% next year, which would be the smallest yearly increase in six years, according to Aon Consulting Worldwide. Experts are pointing to a number of reasons why the increase is not as large as in recent years, including greater use of disease management and wellness programs, as well as generic drugs. [Read More]
Thousands in California whose policies were canceled to be offered new coverage
About 3,400 Californians whose health insurance was canceled by Kaiser, Health Net, and PacifiCare may be eligible for new coverage and for compensation for medical bills they paid while uninsured. The companies came to an agreement with state regulators and in exchange the state Department of Managed Health Care will close investigations into the companies' rescission policies. The state reached similar settlements with Anthem Blue Cross of California and Blue Shield this year. [Read More]
New York fines health plan $600,000
New York's Insurance Department fined Capital District Physicians' Health Plan (CDPHP) $600,000 because it allegedly did not notify its member how they could appeal denied claims. CDPHP reportedly did not provide the information for 121,911 claims submitted between 2004 and 2006. CDPHP has agreed to notify members to make sure they received the proper notices. In a prepared statement, the health insurer wrote that the problem occurred because the company was attempting to reduce paperwork for members. CDPHP is the latest insurer the Insurance Department has fined this year. In April, New York penalized MVP Health Care $150,000 after similar findings, and the state recently fined HealthNow New York Inc., parent of BlueShield of Northeastern New York, $1 million for denying member claims for infertility treatments. [Read More]
Blue Cross Blue Shield of Tennessee settles suit in New Jersey
Blue Cross Blue Shield of Tennessee has agreed to pay $2.1 million to settle a federal complaint over Medicare charges in New Jersey. Riverbend Government Benefit Administrators, a BlueCross subsidiary that provides Medicare payment services for about 4,300 healthcare providers in 47 states, reportedly overcharged several New Jersey hospitals between 2000 and 2002. The government has not alleged any fraud against Blue Cross in the matter. [Read More]
Mistakes to cost Illinois hospitals
Blue Cross and Blue Shield of Illinois is joining a growing list of health insurers who will not pay for certain preventable medical errors. Following Medicare's lead, insurers believe not paying for these so-called never events will make hospitals improve quality, which would save costs. Blue Cross and Blue Shield of Illinois plans to implement the new policy at the end of the year. [Read More]
Illinois governor rewriting bill to improve healthcare access
In an attempt to close the health insurance gap for 20-somethings, Illinois Governor Rod Blagojevich is seeking to allow parents to keep their children on their health insurance until they turn 26—or 30 for children who are veterans. Blagojevich says more than 300,000 Illinoisians between the ages of 19 and 25 are uninsured. [Read More]
Plan reduces health costs for large employers in Wisconsin
The collaboration of 18 large employers in southeastern Wisconsin has saved $32 million in healthcare costs and decreased costs by 9% in two years, according to an analysis. The Business Health Care Group, which includes the 18 large employers, contracted with Humana Inc., in 2005 to create a health plan for its members. The plan, called Humana Preferred, covers more than 93,000 people. A large reason for the healthcare costs savings is because of discounts negotiated by Humana when it set up a network of hospitals and doctors for the employer coalition, according to the analysis. [Read More]
Time is running out
There are only two days left to take part in the 2009 Capitation Rates & Data survey, and we need your help so we can provide the most meaningful data possible. Health plans that offer capitated service can click here and you will be transported to the 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
Iowa officials say health plan could take four years
AP/Chicago Tribune, August 12, 2008
More hospitals sign up for Connecticut's Charter Oak Health Plan
AP/Hartford Courant, August 11, 2008
Which jobs would Blues cut in a merger?
Philadelphia Inquirer, August 11, 2008
Raytheon is ordered to restore health benefits
Arizona Daily Star, August 12, 2008
Massachusetts leaders nip, tuck healthcare policy
Boston Globe, August 11, 2008
Medicare plan changing
Wall Street Journal (subscription required), August 11, 2008
Guaranteed healthcare key plank in Dems' platform
AP/Yahoo News, August 11, 2008
Restitution due some Texas Blue Cross customers
Dallas Morning News, August 11, 2008

On Demand: Health Literacy: Four Ways to Create a Successful Program
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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]
Health Plan Forum
Will Consumers Manage their Health Effectively?
The idea of consumers managing their own healthcare has been around for decades, but have health plans finally found ways to motivate consumers to take better control of their healthcare? [Read More]
From HealthLeaders Media
Getting Paid to e-Prescribe
Just about everybody involved in healthcare has been touting the benefits of e-prescribing. Now some of the proponents are putting money where their mouths are by offering incentives to physicians who make the switch. [Read More]
From HealthLeaders Magazine
Help the Uninsured (Without Going Broke)

HealthLeaders August 2008
The number of people who can't pay much-or anything-for their care just keeps rising. Some hospitals have found new ways to help them while still protecting the financial health of the hospital. [Read More]
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