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Health Insurers Can Learn
From Capitation

Les Masterson, Senior Editor-Managed Care

If these kinds of models are to work, greater collaboration between physicians and health plans is needed. This greater integration is evident not only in capitation, but in areas such as the medical home, population health, consumer-directed healthcare, and quality contracts. [Read More]
  January 21, 2009

Editor's Picks
UnitedHealth Settlements Will Improve Cost Transparency
Two settlements involving UnitedHealth Group will require the nation's largest health insurer to shell out $400 million, cease two databases run by its subsidiary Ingenix, and help fund a new independent database that will collect price information. Supporters of the new independent database say it will create a more transparent process because physicians will have access to the information that Ingenix deemed proprietary. Most insurers use Ingenix to determine "prevailing" and "usual, customary and reasonable charges" for out-of-network physician services. [Read More]
Study: Americans Can Learn from Swiss, Dutch Systems
The public-private healthcare systems in two European nations provide near-universal coverage and could serve as inspiration for U.S. policymakers debating healthcare reforms, according to a recent Commonwealth Fund study. The healthcare policies of Switzerland and the Netherlands have created systems in which a mere 1% of their populations are uninsured because of an individual mandate that requires everyone to purchase health insurance. [Read More]
Public wary of health reform trade-offs
Americans who back healthcare reforms are not as supportive when they hear about potential costs and impacts, according to a recent survey conducted by the Kaiser Family Foundation and the Harvard School of Public Health. Nearly seven in 10 people say they favor requiring employers to provide health insurance or contribute to a fund that pays to cover the uninsured, but only three in 10 people still support the plan if it would force layoffs. [Read More]
Blue Cross, Tufts Medical Center break fee deadlock
Blue Cross Blue Shield of Massachusetts and Tufts Medical Center agreed to a new contract that includes the insurer's Alternative Quality Contract. The insurer says the new contract will help control spiraling healthcare costs while improving treatment. The agreement comes a week after the Bay State's largest insurer signed a similar contract with a hospital and two physician groups. The contract provides higher payments to physicians who meet quality and efficiency targets. [Read More]
Pennsylvania sets conditions for health insurance merger
The Independence Blue Cross and Highmark Inc., merger may not happen unless the new company agrees to make a change in how it markets health insurance in Pennsylvania. The state's Insurance Department has reportedly asked the combined company to use the Blue Shield trademark, but relinquish its rights to the Blue Cross trademark, which would allow another insurer to use the Blue Cross name. Executives from both companies rejected that idea during public hearings in July. [Read More]
Managed Care Headlines
House votes to expand child health insurance
Washington Post - January 15, 2009
Obama will ease restraints on states' health insurance programs for children
New York Times - January 20, 2009
Omnicare loses court dispute with UnitedHealth
Business First of Louisville - January 20, 2009
Insurer plans China joint venture
Reuters - January 19, 2009
WellPoint to cut 1,500 jobs
MSNBC - January 19, 2009
Blue Cross of Michigan wants to cut up to 1,000 jobs, raise rates
Detroit Free Press - January 20, 2009
CIGNA plans to close claims center in Ireland
Hartford Courant - January 21, 2009
Health insurance co-ops haven't found foothold in Tennessee
The Tennessean - January 21, 2009
Impact of New York governor's healthcare plan may be limited
New York Times - January 19, 2009

Webcasts/Audio conferences
February 12: Incentive-Based Compensation Plans to Enhance Physician Performance
On Demand: Strategic Marketing Lessons from Other Industries: 5 Innovative Ideas That Work
On Demand: Financial Meltdown: Managing Through The Crisis
On Demand: In-sourcing vs. Outsourcing Disease and Health Management: What's the Right Mix
On Demand: Health Literacy: Four Ways to Create a Successful Program
Listen Up
Should We Expect Major Reforms in 2009?
Joe Paduda, principal at Health Strategy Associates, talks about healthcare reform, the top healthcare issue for the government to tackle, and what he expects will happen to Medicare Advantage this year. [Listen Now]
From HealthLeaders Magazine
Disease Management 2.0

As skepticism about true cost savings continues to grow, DM shifts its focus beyond chronic disease. [Read More]
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Resources From HCPro

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