HCPro Health Plan Insider - July 8, 2009 | Fraud Prevention as a Way to Finance Healthcare View as a Webpage | Subscribe for Free
Fraud Prevention as a Way to Finance Healthcare
Les Masterson, Senior Editor-Managed Care

The BlueCross BlueShield Association announced last week that some of its Blues plans saved a total of $350 million in 2008 through anti-fraud investigations. As health insurers, employers, and healthcare organizations struggle during a difficult economy, anti-fraud efforts have gained popularity as a way to cut costs without reducing health programs. [Read More]
  July 8, 2009

Editor's Picks
Insurers: Added Regulations Through Health Reform Will Increase Plan Cost
Health insurers are warning that added regulations as part of healthcare reform will result in higher healthcare costs for consumers. Insurers are open to certain new regulations as long as an individual mandate to require all or most Americans to have insurance is also part of the reform package. They oppose other regulations, such as benefit design requirements that include removing lifetime benefit limits and limiting premiums based on differences in age, community, and family size; guaranteed issue without the individual mandate; and coverage mandates. Private insurers say these kinds of requirements would increase premiums and have the biggest effect on less-regulated states. [Read More]
Five Key Questions About an Insurance Exchange
Insurance exchanges are being proposed as a possible way to cover many of the uninsured population without creating a public insurance option. Supporters of the various insurance exchange programs agree that the program would provide one-stop shopping for individuals to compare available plans. The program would also allow for portability so a person wouldn't lose health insurance because of job loss. After those two highlights, however, there is a lot of disagreement as to the actual makeup of the exchange. There are five tough questions lawmakers will have to answer if the insurance exchange remains part of a larger health reform package. [Read More]
Health Reform Calls for Preventive Care, But Questions Persist About Savings
Supporters say prevention will save the nation billions in averted long-term healthcare costs, and recent studies show that Americans support investing in prevention. Prevention has been mentioned as an important piece of healthcare reform. In its health reform draft proposal, The House Committees on Ways and Means, Energy and Commerce, and Education and Labor shed some light on where the prevention dollars would flow, including expanding community health centers, waiving cost-sharing for preventive services in benefit packages, and creating community-based programs to deliver prevention and wellness services. However, there are still questions about whether prevention saves money—most notably from the Congressional Budget Office. [Read More]
CDC: Private healthcare coverage at 50-year-low
About 65% of non-elderly Americans had private health insurance in 2008, which is a 50-year low. The percentage dropped two percentage points from the previous year and about 15% since the early-1980s. The CDC predicted the 2009 numbers could look even worse. Couple that with a recent survey that found more than 60% of 300 business leaders suggested the employer-based insurance model is not sustainable and you see why health insurers see a public insurance option as a potentially fatal blow for their industry. [Read More]
Health savings accounts come under fire
Some lawmakers want new constraints on health savings accounts as part of healthcare reform. Proposals in the Senate would set tighter limits on contributions to HSAs and would require more oversight as to how the money is being spent. This news is no surprise given the leadership change in Washington. Trumpeted as a way to empower consumers and lower health costs, HSAs do not enjoy the same level of support from Democrats, who now control the White House and Congress. [Read More]
Managed Care Headlines
"Rip-off" Insurance Scam Shut Down
Cheryl Clark, for HealthLeaders Media - July 8, 2009
Connecticut regulators to cut Anthem's requests
Cheryl Clark, for HealthLeaders Media - July 8, 2009
Many with insurance still bankrupted by health crises
New York Times - July 1, 2009
Wal-Mart endorses employer mandate
Washington Post - July 1, 2009
Blue Cross Blue Shield of Mass. Rewards Docs for Efficient Quality of Care
Cheryl Clark, for HealthLeaders Media - July 2, 2009

Webcasts/Audio conferences
July 22: Service Line Strategies Workshop 2009: Spine Care
August 18: Advanced Service Line Marketing: New Orthopedics Growth Strategies
August 20: Service Lines Strategies Workshop 2009: Gastroenterology

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
The Right Prescription to Reduce Costs Through Minimally Invasive Surgeries

By implementing a well designed benefits plan that reflects the value of minimally invasive surgery, health plans can continue to advance patient care and overall outcomes, as well as reduce costs related to health benefits. [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]
Sponsor Health Plan Insider

Contact Paul Mattioli, Sr. Director of Sales, at pmattioli@healthleadersmedia.com or call 800.639.7477.
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.
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Read about practical strategies for maximizing the effectiveness of health and disease management programs.
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