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Public Insurance:
Two Questions for Washington

Les Masterson, Senior Editor-Managed Care

With so little known about the specifics of a possible public insurance option, it's difficult to have a serious debate about the plan—and its potential effect on healthcare. The way I see it, a public insurance option could begin to take shape if policymakers answered two key questions. [Read More]
  April 22, 2009

Editor's Picks
How Health Plans Could Benefit From Health IT
The health IT portion of the stimulus law could provide new opportunities for health plans, pharma companies, and other vendors, according to a PricewaterhouseCoopers Health Research Institute report. The report suggests that health insurers could lead an effort to improve health IT exchange, which could result in a quality healthcare system that allows providers easy access to patient records, lets health insurers gain a complete picture of their members' health, engages patients to take better care of themselves, and provides businesses more information about their employees' health. PricewaterhouseCoopers' statement serves as a rare piece of good news for health insurance companies that are seeing employers drop coverage and federal policymakers looking to add a public insurance option to compete against private plans. [Read More]
Health Plans Must Adapt to Changes—or Perish
In its new report Next Generation Health Plan, Computer Science Corporation provided some food for thought for health insurers. Health insurers will need to cut costs, increase efficiency, collaborate with providers, and change the way they pay physicians if they are going to thrive in the changing healthcare marketplace, according to CSC. Health plans face a number of challenges that involve costs and they must adapt to changes or perish, warned CSC. Don't expect to find new, untapped funding sources either. Instead, insurers must reform payments, restructure care, and improve quality, according to the report. [Read More]
Dueling Reports Show Benefits, Problems with Public Option
If lawmakers approve a public insurance option that allows all Americans to join the plan, The Lewin Group suggests private insurers could lose 70% of its members. This shift could have a disastrous effect on private insurers. The healthcare policy research and management consulting firm researched how different public options and payment levels would affect health plans, physicians, and hospitals. Meanwhile, a leading proponent of a public insurance option, UC Berkeley Professor Jacob Hacker, PhD, released a report that highlighted how a public plan would work, and said the public option would allow for competition between private insurers and a public plan. Americans could choose between which open best suits their needs, he said. [Read More]
Employers Shift Costs, Employees Use Benefits While They Last
Employers are seeing an increase in the number of members filling prescriptions and engaging in costly medical procedures in case they lose their health benefits, according to a survey by the International Foundation of Employee Benefit Plans. About one-third of plan sponsors have noticed an increase in the number of participants filling prescriptions and engaging in costly medical procedures before their insurance runs out. Another 24% of companies have seen growth in the number of dependents on their plans. At the same time, nearly 18% of companies have introduced or are considering dependent eligibility audits. More employers are also moving to cost-sharing programs, such as increasing deductibles, coinsurance, and copays. These findings are not surprising, but point to stakeholders facing this difficult economic times in different ways. [Read More]
Senators set timetable for healthcare bills
Two Senate committee chairmen and leading healthcare reform proponents predict major healthcare reform legislation by early June. Sen. Max Baucus, the Montana Democrat who is chairman of the Finance Committee, and Sen. Edward M. Kennedy, the Massachusetts Democrat who is chairman of the Committee on Health, Education, Labor and Pensions, have been working on reform packages to provide health coverage to all Americans. June is an aggressive timetable and I wouldn't be surprised if the legislation slips into fall. [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
Senate Finance Committee Approves Sebelius Nomination
Janice Simmons, for HealthLeaders Media - April 21, 2009
When Patients Finally Get Care They Postponed, Might It Come Too Late?
Cheryl Clark, for HealthLeaders Media - April 16, 2009
Lawmakers debate tax on health benefits
Wall Street Journal - April 21, 2009
Kennedy: Health reform must include long-term care
WBUR CommonHealth blog - April 15, 2009
Study finds gap in Minnesota public, private healthcare
Minneapolis Star Tribune - April 17, 2009
Iowa House OKs modified health reform bill
Des Moines Register - April 21, 2009
Thousands off state healthcare in Washington plan
AP/Seattle Post-Intelligencer - April 21, 2009
Move toward single payer health plan for Colorado dies in Legislature
Denver Business Journal - April 16, 2009
Kaiser Permanente to settle kidney transplant claims for $1 million
Los Angeles Times - April 17, 2009
Court OKs suit over denial of treatment
San Francisco Chronicle - April 20, 2009
Webcasts/Audio conferences

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
Eight Tips for Wellness Program Success

Most companies have reported low and stagnant participation rates in workplace wellness programs. With so much riding on prevention to help cure America's healthcare system, how can wellness programs fulfill the promise of lowering healthcare costs? [Read More]
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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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