HCPro Health Plan Insider - January 6, 2010 | Insurers Finding New Ways to Connect with Members View as a Webpage | Subscribe for Free
Insurers Finding New Ways to Connect with Members
Les Masterson, Senior Editor-Managed Care

I have been writing my health insurance column for HealthLeaders Media for two years so I should know a lot more about the industry than the average American. But I recently received a mailing from my health insurer and found that I was like just about every other confused healthcare consumer. If I had that reaction, what about the millions of Americans who don't know much about insurance—or even worse, those who are not health literate? There are insurers that understand this issue and are trying to reach out and educate members. [Read More]
  January 6, 2010

Editor's Picks
House Democrats to pursue health bill changes
House Democrats want to expand coverage and add health insurance regulations, but whether they have enough leverage to accomplish those goals without losing support is the big question. House Speaker Nancy Pelosi met behind closed doors with House leaders with hopes to convene meetings of House and Senate staff as early as Wednesday to hammer out a compromise bill. House leaders plan to push the Senate to provide more generous subsidies for moderate-income Americans to buy insurance, but added they are willing to kill the public option proposal. That's good news for private health insurers. [Read More]
Senate healthcare bill would still leave millions uninsured
The Senate health reform bill passed on Christmas Eve would leave as many as 23 million people without health insurance by 2018. That would mean about 8% of the population under age 65 would not have health insurance, according to the Congressional Budget Office. Many of the people who will not have insurance would be young adults—the so-called "young invincibles"—who don't believe it's worthwhile to spend money on health insurance because they rarely need healthcare services. Another one-third of the uninsured would be illegal immigrants. [Read More]
Critics on left, right unite against mandate in healthcare overhaul
Though loved by health insurers because it would infuse the industry with millions of new—and in many cases healthier—customers, an individual mandate is still reviled by those on both the left and the right. Both the House and Senate health reform bills have a mandate that Americans buy health insurance, but the health insurance industry is concerned that the mandate will be so watered down that people will rather pay a small fine than buy insurance. Plus, some on the right are charging that an individual mandate is in essence the government forcing Americans to buy a product, while those on the left are concerned that forcing people into the private market won't resolve system issues. Instead, they stand behind a public option, which Capitol Hill leaders are no longer saying is a requirement in health reform. [Read More]
Breakthroughs: Aligning Hospitals and Physicians Toward Value
The current relationship between hospitals and physicians has been built around rewarding for volume of services and not quality. That model is breaking down as reformers in Washington have hospital and physician inefficiency in their sights, with Medicare pushing toward value-based purchasing and experimenting with a payment system that rewards a system of coordinated care. In this HealthLeaders Media Breakthroughs report that you can download for free, four leading hospital systems—Gundersen Lutheran Health System, Sanford Health-MeritCare, SSM Health Care, and Virginia Mason Medical Center—share the lessons they have learned about adding quality to healthcare. [Read More]
Managed Care Headlines
Some foes of healthcare bill hope courts will stop legislation
Washington Post, January 4, 2010
California health insurers' rescission practices are exposed to more scrutiny
Los Angeles Times, January 4, 2010
Big three transfer retiree healthcare liabilities
Wall Street Journal, January 5, 2010
New Cigna CEO focuses on strong overseas growth
AP/Yahoo News, January 5, 2010
Aetna to book charge for layoffs
Wall Street Journal, December 31, 2009
IL governor signs bill allowing some residents to get second opinion on denied medical claims
Chicago Tribune, January 6, 2010
PacificSource Buys Clear One
Les Masterson, for HealthLeaders Media, January 4, 2010

Webcasts/Audio conferences
January 25: Marketing Oncology: Service Line Strategies for Marketers
January 22: Joint Replacement Service Lines: Alignment and Business Strategies for a Changing Environment
On Demand: Service Lines Strategies Workshop 2009: Stroke Care

Listen Up
Reform's Effect on Health Insurance

Alan Katz, principal at the Alan Katz Group, past president of the National Health Underwriters, and blogger who writes about healthcare reform, talks about how reform could impact the health insurance industry. [Sponsored by Emdeon] [Listen Now]
Listen Up
HealthLeaders 20: Cleve Killingsworth

An interview with Cleve Killingsworth, president and CEO of Blue Cross Blue Shield of Massachusetts, who was one of our 2009 HealthLeaders 20. Find out how his company is working with physicians to bring better quality to the healthcare system. [Listen Now]
Listen Up
HealthLeaders 20: A. Mark Fendrick

An interview with A. Mark Fendrick, of the University of Michigan, who is one of the creators of value-based insurance design. Fendrick was one of our 2009 HealthLeaders 20. Find out about how VBID could affect healthcare. [Listen Now]
From HealthLeaders Magazine
Debate Pits Families Against Insurers

Many health insurers have historically covered medical and mental health-related services, but autism advocates and states are pushing for insurers to also pay for behavioral treatment, such as applied behavioral analysis (ABA), which teaches children social, motor, and verbal behaviors and reasoning skills. Activists say that autism is one of the top 10 most common neurological disorders, but is the only one that some health insurers don't cover. For health insurers, there is the question as to whether therapies like ABA should be considered within the scope of health insurance. The key phrase for insurers like WellPoint is whether the services are "medically necessary." [Read More]
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