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Health Reform Is Useless Without Behavior Change
Les Masterson, Senior Editor-Managed Care

I have come to a sobering conclusion. All of this talk about reducing healthcare costs through reform is a waste of time unless the American population takes responsibility for their own health. And I don't see much evidence of personal responsibility built into any of the reform plans. [Read More]
  August 19, 2009

Editor's Picks
Some Democrats say public option essential to reform
Several leading Democrats objected to signals from senior Obama administration officials that they would abandon the idea of a government-run insurance plan if it lacked the backing to pass Congress. President Obama had pushed a nonprofit, government-sponsored insurance plan as an alternative to existing insurance companies. But over the weekend, he minimized the importance of a public option, saying at an event in Colorado that it was just a part of the overall reform effort. One Democrat predicted that without the provision, the bill could lose as many as 100 votes in the chamber. [Read More]
AHIP Criticizes 'Exorbitant' Out-of-Network Charges
The health insurance industry's trade group wants state and federal policymakers to examine what it claims are "exorbitant" out-of-network charges by physicians that are detailed in an industry-sponsored survey. In the analysis of physician out-of-network charges in the 30 largest states, AHIP said there are wide disparities in the cost of various services that were in some cases tenfold higher than Medicare reimbursements for the same service in the same area. [Read More]
Blue Cross and Blue Shield Puts Bank Up for Sale
Blue Cross and Blue Shield's attempt at a healthcare bank appears to be coming to an end with the company's announcement that it is looking to sell Blue Healthcare Bank. The bank offers HSAs to Blue Cross and/or Blue Shield members that are in qualifying health plans. Created only three years ago, Blue Cross has decided to seek a seller for the bank, but company officials say this doesn't mean the plans are stepping away from consumer-driven healthcare. [Read More]
BCBS Study Shows Low Health Plan Administrative Costs
One of the hottest debates in the health insurance world is insurer overhead. The Blue Cross Blue Shield Association added fuel to the debate with a report that said private health plans' administrative costs averaged 9% of premiums across all policies sold and are well below "vastly overstated" estimates offered by proponents of a government-run public plan. The BCBSA report, written by Sherlock Company, states that previous studies showing that private health plans' administrative costs are two to three times higher than actual costs are based on old estimates that don't reflect changes in industry practices, including advances in electronic processing. Advocates for a public plan maintain that the higher administrative expenses for private plans are one reason why a public plan is needed. Health insurance industry officials say the Sherlock study undermines that claim. [Read More]
Policymakers Can Learn From California's Failed Insurance Exchange
Insurance exchanges are seen by some as a compromise to a public insurance plan, but they aren't fool proof. Policy wonks idealizing the idea of health reform through the creation of a national insurance exchange should see a cautionary tale in California, where an ambitious effort crashed and burned in 2006, according to a new report. The state faced a variety of problems with the exchange, including the fact that it attracted higher-risk enrollees. The report by Elliot K. Wicks of Health Management Associates that was prepared for the California Healthcare Foundation offered four tips to avoid those pitfalls. [Read More]
Managed Care Headlines
OIG Audits Find More Providers Overcharging Medicare
Cheryl Clark, for HealthLeaders Media, August 19, 2009
The next healthcare battle: Cutting Medicare Advantage
Los Angeles Times, August 19, 2009
Health co-ops' fans like cost and care, but successful models still rare
Boston Globe, August 19, 2009
Obama injects himself into health talks, despite risks
New York Times, August 13, 2009
For lawmakers, health-plan anger keeps coming
New York Times, August 13, 2009
Bioethicists Counteract Three Healthcare Reform Myths
Janice Simmons, for HealthLeaders Media, August 14, 2009
Connecticut officials seek end to increases in health insurance rates
Hartford Courant, August 13, 2009

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

Listen Up
Making the Business Case for Electronic Swipe Cards

With new national standards paving the way for broad deployment of electronic swipe cards, insurers are doing a massive rollout. Dr. Leonard Wilkerson, UnitedHealthcare's chief medical officer for the Central Region, says the insurer has rolled out 20 million cards to members this year and estimates the technology could save hospitals and physicians more that $1 billion a year. [Sponsored by Emdeon] [Listen Now]
Health Forum
Unleash the Power of the Consumer to Fix Healthcare

A significant disconnect exists in our current framework that disenfranchises the individual from the financial ramifications of their day-to-day lifestyle and health-related decisions. Add to this the rich benefits offered by employers fueled by its tax advantages and you have a formula that has caused the employee to be removed and disengaged from the actual cost of providing their care. [Read More]
From HealthLeaders Magazine
Removing Costs Can Spark Prevention

Education and incentives are needed to bring about significant cultural health behavior. [Read More]
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Resources From HCPro

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