HCPro Health Plan Insider - October 21, 2009 | What are Health Plan Executives Thinking? View as a Webpage | Subscribe for Free
What are Health Plan Executives Thinking?
Les Masterson, Senior Editor-Managed Care

Health leaders spend most of their time in their own silos. This communication breakdown has left health leaders heavily guarded in their bunkers with hurt feelings and often times not understanding the other healthcare pillars. This has also led to health leaders from the different groups having quite different opinions about healthcare and how to improve services while reducing costs. One only needs to view the current health reform debate to show there are varying opinions on how best to proceed. [Read More]
  October 21, 2009

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HealthLeaders Media Industry Survey for Health Plan Leaders is now open online. Included this year are new questions that seek your thoughts on the HIT stimulus package and healthcare reform efforts, among others. Plus, we build on key benchmark questions from last year, checking on your top priorities and your assessment of key population health initiatives. This comprehensive survey should take about 14 minutes to complete. Be sure to provide contact information and we'll enter your name in a drawing for a $1,000 gift card.
Obama Takes Aim at Insurance Industry's Antitrust Exemption
President Obama aimed sharp criticism at the health insurance industry over recent actions related to health reform?and implied he may push for legislation now pending on Capitol Hill to dissolve the industry's 60-year-old antitrust exemption. Obama's statements came within days of a Senate Judiciary Committee hearing in which Senate Majority Leader Harry Reid testified to repeal health insurance and medical malpractice insurance companies' antitrust exemption, which is part of the McCarran Ferguson Act. Congress is unlikely to repeal the exemption. This sounds more like a bullying tactic to keep insurers in line. [Read More]
Medicare Advantage premiums expected to rise 25% next year
Seniors will pay an average of 25% more for Medicare Advantage premiums next year because of more federal regulation and insurers dropping out of the private Medicare plan. The average premium will increase to $39 a month for all Medicare private plans from about $32 this year, said Timothy Hill, deputy director for the Center for Drug and Health Plan Choice at the federal agency that manages Medicare. Private insurers face a 4.5% payment cut next year. Democrats, most notably President Obama, have criticized Medicare Advantage "overpayments" and the payment cut is seen as the first step in reducing how much the government pays private insurers for Medicare Advantage. The number of Medicare Advantage plans will drop by more than 40%, to 73,337 next year, according to an Avalere analysis of Medicare data. [Read More]
Blue Shield is ousted from California's high-risk health insurance pool
California has dumped Blue Shield of California, the state's second-largest not-for-profit health plan, from the state's high-risk medical insurance pool because its premiums were too high. The Major Risk Medical Insurance Program insures more than 6,700 Californians who have been shut out of the private health insurance market because of pre-existing conditions. Blue Shield's premiums have been substantially higher than those of the other two private insurers in the program, Kaiser Permanente and Anthem Blue Cross of California, according to the state. High-risk pool officials said they put Blue Shield on notice last year over concerns about its high premiums and the insurer's participation slipped to about 80 enrollees this year. [Read More]
Managed Care Headlines
Three Areas of Debate When Reform Bill Reaches Senate Floor
Janice Simmons, for HealthLeaders Media, October 14, 2009
White House aides reaffirm public option is not mandatory
Washington Post, October 19, 2009
Poll: Most Americans support public option
Washington Post, October 20, 2009
Massachusetts governor wants state to review healthcare premiums
Boston Globe, October 20, 2009
Medical home model designed to improve preventive care, communication
Chicago Tribune, October 20, 2009
Basic Medicare premium to rise 15% in 2010
New York Times, October 20, 2009

Webcasts/Audio conferences
October 29: Flexible Medical Staff Models of the Future
October 22: Marketing to Physicians: Build Relationships to Increase Referrals
On Demand: Service Line Strategies Workshop 2009: Spine Care
Listen Up
Insurance Exchange Lessons from New York

Vince Ashton, executive director of HealthPass, a New York City-based health insurance exchange, discusses the exchange and what health insurers and policymakers can learn from the New York experience. [Sponsored by Emdeon] [Listen Now]
From HealthLeaders Media
Shedding (Not Shifting) Costs

A pilot program in California aligns hospital, physician, and insurer—and creates incentives to cut costs and boost quality. [Read More]
From HealthLeaders Magazine
Disease Management's Struggle to Remain Relevant

Disease management, once trumpeted as a way to control costs and improve patient outcomes, has been the subject of a number of recent reports questioning whether it actually reduces health costs. There are four ways disease management can reclaim a vital role in healthcare. [Read More]
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