HCPro Health Plan Insider - May 6, 2009 | Legislating MLR Leads to Unintended Consequences View as a Webpage | Subscribe for Free
Legislating MLR Leads to Unintended Consequences
Les Masterson, Senior Editor-Managed Care

On the surface, limiting health insurers' profits and administration costs sounds like a sensible idea. Why should health insurance executives get to pocket profits or pad their reserves? Shouldn't that money go to medical care? Well, it's not that simple. [Read More]
  May 6, 2009

Editor's Picks
Report: Medicare Advantage 'Extra Payments' Will Reach $11.4 Billion This Year
The federal government will pay private insurers $11.4 billion more for Medicare Advantage plans this year than what the same beneficiaries would cost traditional Medicare, according to a new report from The Commonwealth Fund. The $11.4 billion will push up the "extra payments" paid to private insurers to $43 billion since 2004. The report adds more ammunition for critics, including the Obama administration and Democrats, who think the private Medicare program is too expensive. The feds will cut Medicare Advantage payments by between 4% and 4.5% in 2010 and the Obama administration has targeted the program as a special interest giveaway. What I would like to see is an independent study that compares the extra payments to how the program is affecting overall healthcare costs, beneficiary out-of-pocket expenses, and member satisfaction. Only then can we have an educated debate about Medicare Advantage. [Read More]
Increasing Losses of Health Coverage May Put Pressure on for Public Insurance
A leading senator is suggesting legislators should push a public insurance option to the side while they work on improving the healthcare delivery system. A number of lawmakers and special interests are promoting a public insurance option as a way to compete with private insurers, increase the number of insured Americans, and lower healthcare costs. The president of the Center for American Progress said 65% of uninsured Americans in the U.S. are employed, which shows that the connection between having a job and having health insurance is "breaking down in part because more and more employers cannot afford to cover their workers." [Read More]
CDC: More Adults Reporting Disabilities
Disease management companies have a real opportunity for growth. You only need to read the recent Centers for Disease Control report to understand that. The report showed that more than one in five American adults is reporting that they have a disability. That number has increased by 3.4 million between 1999 and 2005 and most assuredly will continue to grow over the next two decades. The CDC is working with state health departments and community health agencies to expand the availability of health self-management, education, and physical activity programs that could potentially reduce the impact and cost of the disabilities. So, the question is: Are disease management programs part of reversing that trend or is the DM industry yesterday's news? [Read More]
Pharmacist Coaches Help Chronic Disease Patients
The Diabetes Ten City Challenge, which the American Pharmacists Association Foundation created to test whether the pharmacist coach model works in diverse geographies and various employer types, showed that combining pharmacist coaches with value-based insurance design helped diabetic patients manage their chronic disease. The program reduced overall healthcare costs and out-of-pocket expenses, improved key clinical measures, and fostered improvements in preventive care measures, according to the study. These results are the latest to show that pharmacists can play an important role in healthcare, but is the industry listening? [Read More]
Health insurers agree to end higher premiums for women
Health insurers have agreed to stop charging higher premiums to women. Karen M. Ignagni, president of America's Health Insurance Plans, made the offer in testifying before the Senate Finance Committee. It was the latest concession by insurers as Congress drafts legislation to overhaul the $2.5 trillion healthcare industry. Insurers earlier agreed to accept all members regardless of health status with the agreement that lawmakers mandate coverage for all Americans, but the industry still opposes a public insurance option that would compete against private insurers. Are these the kind of baby steps we should expect for healthcare reform this year? [Read More]
Managed Care Headlines
WellCare agrees to pay $80 million to settle Medicaid case
Wall Street Journal - May 6, 2009
How will the uninsured fare in swine flu outbreak?
AP/Yahoo News - May 5, 2009
Need for cost data slows healthcare overhaul
Wall Street Journal - May 5, 2009
Top Senate Democrat offers middle ground on healthcare
New York Times - May 5, 2009
Community Health Centers Could Save Money, Promote Care
Janice Simmons, for HealthLeaders Media - May 4, 2009
High healthcare costs taking toll on Massachusetts insured
Boston Globe - May 4, 2009
CIGNA cost estimator available to providers
Hartford Courant - April 29, 2009
Aetna stock falls 10% on medical cost worries
Hartford Courant - April 30, 2009

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George Van Antwerp, vice president, Solutions Strategy Group, Silverlink Communications, discusses how health insurers are saving money through pharmacy programs. [Listen Now]
Healthcare Forum
Part D: Effective Management to Optimize Your Bottom Line

Understanding and properly managing Prescription Drug Events is vital to a Medicare Part D plan's financial success, as good PDE data allows for accurate reconciliation with the Centers for Medicare and Medicaid Services, and ultimately, revenue optimization for the plan. [Read More]
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