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Are HSAs Ready to Battle a Public Plan?
Les Masterson, Senior Editor-Managed Care

Once trumpeted as the best hope to control spiraling healthcare costs, consumer-driven health plans have been largely pushed aside during healthcare reform talks in Washington. However, health savings accounts could be a way for private plans to compete against a public plan because HSAs will help keep costs down and provide a distinct difference to a public plan with low administration costs. [Read More]
  May 20, 2009

Editor's Picks
Senate Committee Explores New Payment Rates, Taxes to Fund Reform
The Senate Finance Committee is reviewing a number of proposals to fund major healthcare reform this year. The policy options focus on three main areas of potential funding sources: savings achieved from within the healthcare system from reductions in current levels of spending; re-evaluating current health tax subsidies; and changing non-health tax provisions. The committee is re-examining Medicare and Medicaid payment rates and taxing employee health benefits, but the areas that will probably get the most play in the mainstream press are proposed taxes on alcoholic beverages and soda. [Read More]
Is Healthcare Better Without Doctors?
Consumers are increasingly getting their healthcare outside of the traditional physician-based healthcare system—and that may be a good thing, according to a new report. The author points to the rapid expansion of drugs and devices to test, monitor, and treat medical conditions without the physician office visit that defined access to healthcare a decade or two ago. In fact, a physician isn't required in the process at all, she adds. I agree healthcare needs to do a better job implementing remote patient monitoring and utilizing nurses and pharmacists, but there is no substitute to having a seasoned physician leading a patient's care. [Read More]
Employee Healthcare Costs Rise, But We're Not at Tipping Point Yet
The total 2009 medical cost for a typical American family of four in an employer-sponsored PPO will increase by more than 7% this year and those same families will pay $500 more for healthcare than they did in 2005, according to the fifth annual Milliman Medical Index. Though employees will spend more in 2009, the total medical cost increase is actually the lowest annual trend rate since the MMI started five years ago—and is the third consecutive rate decrease. With another 15% added to employee premiums and 5% in out-of-pocket costs, I asked Ron Cornwell, principal and consulting actuary at Milliman, if we have reached a tipping point and if employers will soon have to find other ways to cut their costs. He said there is still room to shift "some of the burden" of medical costs onto employees. In other words, expect more cost shifting in the near term. [Read More]
Bill Would Test Value-Based Insurance in Medicare
Medicare may soon test value-based insurance design in its population. Pioneering employers have trumpeted VBID as a way to reduce long-range health costs while improving patient outcomes. Bipartisan legislation, filed by Sen. Kay Bailey Hutchinson (R-TX) and Sen. Debbie Stabenow (D-MI), would create a Medicare pilot to test whether the concept would work in the elderly population. I have reported on VBID a number of times and I think the concept could work perfectly in the Medicare population. [Read More]
Docs Spend About $31B Haggling with Insurers Annually
Physicians spend three hours per week—43 minutes on average per workday—haggling over claims, credentialing, authorizations, formularies, and other issues with health insurance plans, according to a new study. The researchers found that total staff interaction time systemwide converted to dollars equaled $21-$31 billion annually—an average of more than $68,000 per physician per year. Robert Zirkelbach, spokesman for America's Health Insurance Plans, says AHIP is also concerned about complicated, time-consuming, and expensive administrative processes that waste money and time for health plans. Both sides agree. Now, let's hope they can come together to streamline the process. [Read More]
Blue Shield of California health insurance rescission case to go to trial
A jury will get to decide for the first time about an insurer's rescission policies. The case involves Blue Cross of California canceling a Cypress, CA, man's policy after he was injured in a disabling care accident. Blue Shield has contended that it was within its rights to cancel the coverage because the couple reportedly misrepresented the man's true weight and failed to list his medical history, including hypertension and headaches, on their application. An appellate court has ruled that insurers should not wait until members are sick or injured before verifying their medical history. If an insurer does wait, the court ruled, it loses its chance to cancel coverage unless it proves applicants intentionally misrepresented medical history that would have rendered them ineligible. Lawmakers and the public do not look kindly on health insurer rescission policies so expect more oversight on the issue regardless on this case's outcome. [Read More]
Editor's Note
From all of us at HCPro, Inc., have a safe Memorial Day holiday. Health Plan Insider will not publish next week, but will return with a new issue June 3.
Managed Care Headlines
Obama calls for urgency in passing healthcare bill
Wall Street Journal - May 14, 2009
Healthcare hits a snag in Senate
Washington Post - May 18, 2009
Advocates Flog CMS for Ending CT Colonography Coverage
John Commins, for HealthLeaders Media - May 15, 2009
House Democrats consider mandate for employer health insurance
Bloomberg/Yahoo News - May 15, 2009
Labor groups blast Senator on health benefits tax
New York Times - May 20, 2009
Criminal Charges Possible in WellCare Fraud Case
Kristen Kohrt, for HealthLeaders Media - May 14, 2009
WellCare settles SEC accounting probe
Wall Street Journal - May 19, 2009
Poll: Sizeable Minority of Americans Would Consider Medical Tourism
John Commins, for HealthLeaders Media - May 20, 2009
Employers Show President How Better Health Improves Bottom Line
Janice Simmons, for HealthLeaders Media - May 13, 2009
Bill expanding health plan signed in Iowa
DesMoinesRegister.com - May 20, 2009

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From HealthLeaders Media
Medicare: Have We Tried Everything Yet?

Winston Churchill once said that you can depend on Americans to do the right thing—after they've tried everything else. With Medicare, we've tried just about everything else. So now what? [Read More]
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