HCPro Health Plan Insider - April 8, 2009 | Is First Medicare Advantage Cut a Fatal Blow? View as a Webpage | Subscribe for Free
Is First Medicare Advantage
Cut a Fatal Blow?

Les Masterson, Senior Editor-Managed Care

CMS reduced Medicare Advantage reimbursements between 4% and 4.5% for 2010 and more cuts are expected in the coming years. If the 2010 rate drop was a one-time payment cut, most Medicare Advantage insurers would probably stay in the program and look for ways to cut costs while maintaining the same level of services. But with more payment cuts expected, don't be surprised if insurers pass more costs onto beneficiaries or simply drop out of the program. [Read More]
  April 8, 2009

Editor's Picks
Study finds many on Medicare return to hospital
About one-fifth of Medicare patients are readmitted within a month of being discharged and one-third return to the hospital within 90 days of discharge, according to a New England Journal of Medicine study. This revolving door is costing the U.S. billions of dollars annually, and the author of the study said the results show a problem with the "increasingly fragmented healthcare system." This could be prevented with better follow-up care and care coordination. The study should serve as ammunition for the Obama administration, which is looking to revamp the payment system to pay for quality and care coordination rather than fee-for-service. The administration must be careful though. Doctors are already opting out of Medicare and any payment change will need to take that into consideration. [Read More]
Georgia health insurers scrutinized over reimbursements
The Ingenix aftermath has reached Georgia as the state insurance commissioner launched an investigation into how Georgia health insurers calculate payments for out-of-network care. The commissioner has asked 18 major insurers to provide that information as well as inform him whether the Ingenix database was used. The state's medical association is part of a class-action lawsuit with the American Medical Association that alleges that insurer WellPoint colluded with Ingenix to underpay physicians. The Senate Commerce Committee is also looking into the situation, which has already resulted in UnitedHealth, which owns Ingenix, agreeing to create a new, independent database and paying $350 million to settle class-action lawsuits. In another case involving out-of-network payments, Connecticut this week ordered Health Net of the Northeast to pay $1.3 million in fines and restitution because of improperly denying or underpaying claims and other state law violations. [Read More]
Consolidation of insurers a concern for medical providers
With talk of potential health insurer mergers, doctors and hospitals are concerned that larger insurers could limit consumer choice and lower reimbursements. According to the American Medical Association, one in six U.S. metropolitan areas is dominated by a single health insurer, but insurers defend consolidation as a way to better control costs through efficiencies and leveraged buying power. Some of the possible consolidations recently discussed involved health insurer giants Aetna and UnitedHealth Group merging with small insurers. Health insurer consolidation will happen in the coming year. The question is: Will mergers lead to lower physician payments and less consumer choice? [Read More]
Subsidized care costs Massachusetts $794 million
Massachusetts' subsidized care increased by nearly 25% in the last fiscal year because employers, especially large retailers, relied on state subsidies to provide health benefits to employees. Wal-Mart and Stop & Shop topped the list of businesses with employees receiving public health benefits, which is not a surprise. The third place employer might surprise you—the commonwealth of Massachusetts. With the Commonwealth forking over $794 million to care for employees, expect state officials to look at increasing the $295 per employee penalty to fund the uninsured care pool. [Read More]
Study raises questions about public health plan
A public insurance option could put private health insurers out of business, according to a Lewin Group report. The public insurance option, which is a leading healthcare reform proposal in Congress, would create a government plan to compete against private insurers. The study reported that if the plan were available to all employers and individuals—and the public option paid doctors and hospitals at the same rate as Medicare—the public plan would balloon to 131 million members, cause private insurance enrollment to plummet, and mean lower reimbursements for doctors. On the plus side, the public option would create a lower cost alternative for consumers and would cut the number of uninsured Americans in half, according to the study. [Read More]
Are You a Top Leadership Team?
HealthLeaders Media is gearing up for its fifth year of the Top Leadership Teams in Healthcare program. Health insurers with varied specialties have won the Health Plan portion of the contest over the past three years, including Harvard Pilgrim Health Care, Erickson Advantage, and CareSource Management Group. If you think your organization has an outstanding teamwork story to share, submit your entry today. The deadline for submissions is April 30.
Managed Care Headlines
Insurance gender bias efforts stall in Connecticut legislature
Hartford Courant - April 7, 2009
500,000 Californians lost health insurance, report says
San Francisco Chronicle - April 2, 2009
More Southern California residents forgo preventive care, providers say
Los Angeles Times - April 8, 2009
Holes in Louisiana health coverage noted
New Orleans Times-Picayune - April 8, 2009
Soaring medical insurance costs are a sore spot for California employers
Los Angeles Times - April 6, 2009
New Jersey budget would limit expansion of FamilyCare
Philadelphia Inquirer - April 6, 2009
Advocates: Rule knocks Mississippi poor off Medicaid
Associated Press - April 3, 2009
Health group volunteers Tennessee as test site for universal coverage
The Tennessean - April 6, 2009

Webcasts/Audio conferences
April 20: Service Lines Strategies Workshop 2009: Joint Replacement
April 28: Compensation Packages to Recruit and Retain Physicians in Today's Economy
April 29: Marketing Neurosciences: Service Line Strategies for Marketers
May 12: Service Lines Strategies Workshop: Cardiovascular Physician Alignment
On Demand: 5 Ways to Improve the Patient Experience at Your Hospital
Listen Up
Money-Saving Pharmacy Options

George Van Antwerp, vice president, Solutions Strategy Group, Silverlink Communications, discusses how health insurers are saving money through pharmacy programs. [Listen Now]
Healthcare Forum
Reforming the Reform Debate

Healthcare reform will elude us unless we have one goal and three clear initiatives that will structure a system in which each of the interdependent components work together, wrote Bob Stone, an executive vice president and founder of Healthways. [Read More]
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