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Health Insurers Debate
Whether Bigger is Better

Les Masterson, Senior Editor-Managed Care

WellPoint's decision to sell its pharmacy benefit management business comes as no surprise. In this difficult economic environment with employers dropping health coverage, insurers are reviewing their programs to see what can be outsourced. [Read More]
  April 15, 2009

Editor's Picks
Member Knowledge Has Monetary Value for Health Plans
Health plan members care most about coverage, benefits, and provider choice, but members' knowledge about their plans underlies all of those issues. That fact was evident in the results from the annual J.D. Power and Associates' National Health Insurance Plan Study. Member experience is one of those difficult-to-define topics that financial experts have a tough time gauging, but the survey found that positive member experience and plan knowledge have a direct correlation to costs. [Read More]
CMS Names 14 Communities for Hospital Readmissions Project
With CMS' announcement of a three-year pilot program to eliminate unnecessary hospital readmissions, the federal government may have sparked a renaissance in disease management. My colleague John Commins wrote about how the study will include 14 Care Transitions Projects throughout the country. CMS is hoping to reverse the trend of rehospitalization in the Medicare population, which reportedly cost the country $17.4 billion in 2004. The reason why I think this could be a renaissance for DM is that facilities will need help to care for discharged patients, and a combination of DM nurses and remote patient monitoring could be a recipe for cost savings and improved patient outcomes. [Read More]
AG ends probe into BCBS of Texas physician rating program
Blue Cross Blue Shield of Texas has agreed to stop ranking physicians through claims data. The Texas insurer did not acknowledge any wrongdoing, but agreed to no longer use claims data to measure a physician's affordability. The insurer will still use claims data to measure a physician's compliance with certain accepted procedures. In response to Blue Cross Blue Shield of Texas' decision, the Texas Attorney General's office agreed to end a probe into the insurer's physician rating program. Insurers have created physician rating programs as a way to provide more information for consumers about price and quality, but there have been a number of stumbling blocks along the way, such as this case in Texas. [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
Novel approach to health plans gains traction
Wall Street Journal - April 14, 2009
America's uninsured haven't shown collective power
AP/Yahoo News - April 13, 2009
Diabetics skimp on lifesaving care in recession
AP/Yahoo News - April 14, 2009
The doctor will see you: Log on now
Minneapolis Star Tribune - April 13, 2009
Tufts' Roosevelt: More than one payment model needed to align goals, achieve quality
WBUR CommonHealth blog - April 13, 2009
New Jersey to use tax forms to enroll uninsured kids
AP/Philadelphia Inquirer - April 15, 2009
Medical home approach brings back managed care
Boston Globe - April 9, 2009
West Virginia healthcare bills include medical home pilots
AP/USA Today - April 15, 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
From HealthLeaders Magazine
Health Plans: How Much Is Enough?
As more states consider requirements for payers' expenditures on direct medical care, many insurers reject the idea that the medical loss ratio equals a plan's quality. [Read More]
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]
Sponsor Health Plan Insider

Contact Lisa Brown, Director of Integrated Sales, at lbrown@healthleadersmedia.com or call 781.639.1872.
Resources From HCPro

Compare your organization against national averages.
Learn how increased collaboration between providers and managed care payers has the potential to reduce costs, improve processes, and enhance patient care.
Discover how to integrate wellness into your DM programs.
Read about practical strategies for maximizing the effectiveness of health and disease management programs.
Learn how to educate and engage members.
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