HCPro Health Plan Insider - August 20, 2008 | Physicians 1, DM 0 View as a Webpage | Subscribe for Free
Physicians 1, DM 0
Les Masterson, Senior Editor-Managed Care
CMS has released another round of positive results from the Physician Group Practice demonstration project, which is in stark contrast to the outcomes from the disease management-inspired Medicare Health Support demonstration that is ending this year. But don't write DM's obituary just yet. [Read More]
  August 20, 2008

Editor's Picks
U.S. says Amerigroup settles Medicaid case
Amerigroup Corp., will pay $225 million to settle claims that it avoided enrolling pregnant women and the sick into its Medicaid programs. The company reportedly excluded those patients because they were more expensive to treat. The Virginia Beach, VA-based company, however, did not admit wrongdoing under the agreement. [Read More]
GM to crack down on health coverage
In an attempt to cut its nearly $5 billion annual healthcare bill, General Motors is taking aim at employees who are placing ineligible dependents on their insurance. GM is asking its 67,000 hourly workers to voluntarily remove those who are illegally getting coverage. The car company may demand reimbursement for health costs for those with ineligible dependents. As I mentioned earlier this month, eligibility audits have become more popular recently as companies look for ways to cut healthcare costs. For more information about these audits, click here. [Read More]
New Jersey's biggest insurer may turn for-profit
In an attempt to gain more access to capital markets for investments, Horizon Blue Cross Blue Shield has filed to become a publicly held for-profit company, which could bring in $1 billion for healthcare in the state. The proposal is a concern to those who believe the change would switch the plan's emphasis from patients and employers to shareholders. Horizon says the value of the insurer on the open market, which the company estimates at a minimum of $1 billion, would go into a charitable foundation that would help pay for healthcare for the needy. Thirteen other Blue Cross Blue Shields have turned from nonprofit to for-profit, according to Horizon. [Read More]
439,000 more get health coverage in Massachusetts
Nearly 75% of the previously uninsured in Massachusetts now have health insurance, according to a report released by Governor Deval Patrick's administration. Since Massachusetts implemented its health insurance program, 439,000 residents have enrolled in the plans, including about half of them who signed up for unsubsidized private insurance. The report also claimed emergency room visits have decreased because more citizens are enrolled in health insurance. [Read More]
Highmark, Blue Cross merger would raise executive pay
Executives will receive hefty raises if the proposed merger of Highmark Inc., and Independence Blue Cross is approved, according to documents filed with the Pennsylvania Insurance Department. Highmark's chief executive would get a 31% raise, to $3.9 million from $2.97 million, including incentives, and Highmark's chief financial officer, could get a $635,098 increase in total pay, which includes possible annual and long-term incentives. The merger is also expected to eliminate between 745 and 1,200 jobs. Some advocates are concerned with the proposed raises and criticize the Blues for operating more like for-profit insurance companies. [Read More]
Managed Care Headlines
Health insurers hedge their bets
BusinessWeek, August 15, 2008
More health insurers competing in individual coverage market
Hartford Courant, August 18, 2008
Medicare Web site confounds many seniors
HealthDay/Washington Post, August 20, 2008
Nine firms submit healthcare plans to cover adults under Cover Florida
St. Petersburg Times, August 20, 2008
States won't be sanctioned over kids' health insurance
AP/USA Today, August 15, 2008
Study: Insurance matters when it comes to kids' healthcare
Washington Post, August 15, 2008
McCain's health insurance plan: More radical than Democrats'?
Dallas Morning News, August 18, 2008
Missouri program offers Medicaid recipients visits to primary care doctor
Kansas City Star, August 14, 2008
Blue Cross and Blue Shield of North Carolina hit with class action
Raleigh News & Observer, August 18, 2008
Georgia governor touts drug discounts for uninsured
Atlanta Journal-Constitution, August 15, 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
Developments in DM
Playing to Good Health
The Nintendo Wii has taken the country by storm and is being promoted as a healthier alternative to video game consoles that don't require full-body participation. Now, health leaders are exploring whether gaming has a place in healthcare, most notably in chronic care and in teaching children about healthy living. [Read More]
Listen Up
Individual insurance abounds
The individual health insurance market has grown as more employers have cut health benefits. Fred Karutz, senior vice president of business development at Norvax, an online health insurance technology company, talks about the individual market and how the shift to individual policies is affecting healthcare. [Listen Now]
From HealthLeaders Magazine
Help the Uninsured (Without Going Broke)

HealthLeaders August 2008
Sure, your organization offers sophisticated, compassionate care. But the patients of tomorrow will want much more than that. [Read More]
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