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Quality Could Save Medicare Advantage
Les Masterson, Senior Editor-Managed Care

Lost in the public insurance and health reform debate last week was a Medicare Payment Advisory Committee report issued to Congress that criticized Medicare Advantage for paying private insurers billions more than what the government pays providers through traditional fee-for-service Medicare—despite the fact that many Medicare Advantage programs offer similar services. [Read More]
  June 24, 2009

Editor's Picks
Drug Industry Agrees to Fund Portion of Medicare Doughnut Hole
The ultimate result of healthcare reform will probably not satisfy most Americans, but the reform debate is already changing healthcare. One example is the news this week that the Pharmaceutical Research and Manufacturers of America agreed to pay $80 billion over the next decade to assist Medicare beneficiaries and defray drug costs. Under the deal, drug companies would pay as much as half of the cost of brand name drugs for lower and middle income seniors in the so called Medicare "doughnut hole," which is a gap in prescription coverage in which the beneficiary pays the full price for medication without help from Medicare. The pharmaceutical companies also have agreed to pick up some of the costs of the president's health reform plan. [Read More]
Three Common Reasons Why Some Insurers Don't Pay Fast Enough
In its annual PayerView Rankings, athenahealth found that health insurers are paying physicians 5% faster and denying 9% fewer medical claims than last year. That's the good news. The negative is that some payers still have a ways to go, most notably state Medicaid programs. Through its research, athenahealth found three trouble spots often lead to delayed physician payments: health insurers' varied policies and procedures, real-time claim adjudication that merely adds work on providers, and insufficient resources for providers, which leads to misinformation and additional phone calls to resolve problems. [Read More]
Co-ops gain backing as alternative to government insurer
Rather than a public insurance option, some lawmakers are pushing nonprofit health insurance cooperatives as a compromise. The leading supporter of the idea, Democratic Sen. Kent Conrad of North Dakota, said his proposal stems from his experience with the rural electricity, farming, and telephone co-ops in his state that are owned and run by members. His plan includes state or regional entities that would sell insurance to small businesses and individuals and negotiate rates with healthcare providers. Many Republicans support the idea, but private insurers say they need more information before deciding whether to back the plan. [Read More]
Healthcare Consumers Interested in Technology, But Are Not Using it Now
Health insurers have spent millions on improving member outreach on the Web, but most people still don't visit their health plans' Web sites or believe their insurers support their health, according to a new Microsoft survey that was conducted by Kelton Research. That sobering news is balanced, however, with some positive findings. Survey respondents are interested in their health plans connecting with them via e-mail and phone for electronic coaching, but they want those services integrated into their lives. Patients want providers and insurers to come together to help them improve their health habits and self-manage their conditions. This will require insurers to implement a "new generation of technology designed to proactively improve health and coordinate care at the individual and community levels," according to Microsoft. [Read More]
Massachusetts cuts its health coverage by $115 million
Massachusetts officials cut $115 million, or 12%, from Commonwealth Care, the subsidized portion of the commonwealth's universal health coverage program. The Connector Authority is dealing with a state budget crisis and a surge in enrollment because of employer layoffs. Two ways the Connector Authority will find savings is by no longer automatically assigning a plan to those who enrolled but forgot to choose a health plan; and eliminating dental coverage for Commonwealth Care members. [Read More]
Editor's Note
From all of us at HCPro, Inc., have a great Fourth of July holiday. Health Plan Insider will not publish next week, but will return with a new issue July 8.
Managed Care Headlines
House's Health Reform Draft Features Public Option
Janice Simmons, for HealthLeaders Media - June 19, 2009
Public Insurance Advocates Don't Want Compromise on Public Option
Cheryl Clark, for HealthLeaders Media - June 24, 2009
Obama Emphasizes Support for Public Plan Option
Janice Simmons, for HealthLeaders Media - June 24, 2009
Despite Recession, Medical Costs Will Grow in 2010
John Commins, for HealthLeaders Media - June 19, 2009
Feds Provide $6 billion for CHIP Expansion
John Commins, for HealthLeaders Media - June 19, 2009
In poll, wide support for government-run health
New York Times - June 22, 2009

Webcasts/Audio conferences
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Listen Up
Prevention as Part of Healthcare Reform

Alere CEO Ron Geraty, MD, discusses how management of preventable health risks and chronic illness could save billions and should be a part of healthcare reform. [Sponsored by Emdeon] [Listen Now]
Health Forum
Healthcare Reform Takes More than Technology & Government

It is not the clinical care that is the problem. It is the administrative processes that surround clinical care that creates the increases in rapidly growing healthcare costs, healthcare system inefficiencies, and opportunities for error in all aspects of patient care, as well as, practice, facility, and health insurance operations. [Read More]
From HealthLeaders Magazine
Employers Paying Now to Save Later

Value-based insurance design departs from the growing trend of passing along costs to consumers. [Read More]
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Resources From HCPro

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