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Pilot Projects Can Show Promise, But Often Come up Short
Joe Cantlupe, Senior Editor-Managed Care

Although the health reform bills showcase the potential of pilot and demonstration projects as cost-cutters for the system, experts are cautious about implementing them. A study by the Centers for Medicare and Medicaid Services, which analyzed several demonstration projects, urges officials to carry out the programs with caution, saying the demands for data and other information are challenging. A key problem is the lack of a national data system. [Read More]
  January 20, 2010

Editor's Picks
More Employers Unhappy with Health Insurers, Says PWC Study
U.S. employers, whether representing big firms or in small partnerships, are becoming less satisfied with insurers, according to a new PricewaterhouseCoopers Health Research Institute study. The problem becomes magnified in tough economic times. Employers are looking for various strategies, such as information technology, to help reduce waste in healthcare spending and better engage with employees. [Read More]
Congress, Labor Leaders Agree on Revised Cadillac Health Plan Tax
In its work on the healthcare reform bill, White House and Congressional leaders held marathon negotiations with labor unions, reportedly hammering out the issue of taxing employees' high-cost or "Cadillac plans." Under the plan, the threshold at which the 40% tax would kick-in with high-cost plans would change. The threshold would now be for families whose plans' value reach $24,000?up from $23,000; for individuals, the $8,500 threshold is likely to remain the same. [Read More]
Security Breach Puts 500,000 BlueCross Members' Data at Risk
Private information for approximately 500,000 customers in at least 32 states was put at risk from the theft of 57 hard drives from a BlueCross BlueShield of Tennessee training facility last October. The hard drives containing 1.3 million audio files and 300,000 video files related to coordination of care and eligibility telephone calls from providers and members had reportedly been stolen from a leased office in a Chattanooga strip mall that once housed a BCBS of TN call center. [Read More]
California limits HMO wait times
California regulators have had enough with long waits many people have had to endure to see a doctor. Regulators are implementing new rules that specify how quickly patients in health maintenance organizations must be seen, according to a Los Angeles Times report. Under the proposal, the California Department of Managed Health Care will require that patients be treated by HMO doctors within 10 business days of requesting an appointment and by specialists within 15 days. Patients seeking urgent care that do not require prior authorization must be seen within 48 hours. [Read More]
Managed Care Headlines
Fraud Prevention Program Axed in Health Reform Plan
Cheryl Clark, for HealthLeaders Media, January 15, 2010
Health Reform Pilot Projects Look to Transform Healthcare
Joe Cantlupe, for HealthLeaders Media, January 15, 2010
Hey, doctors: Tax expansion could pay for healthcare overhaul
Wall Street Journal Health Blog, January 15, 2010
Seven Health Reform Initiatives Could Take Effect This Year
Joe Cantlupe, for HealthLeaders Media, January 14, 2010
Medicaid provision for Nebraska raises ire
Washington Post, January 18, 2010
CT AG's Office Suing Health Net for Member Data Breach
Les Masterson, for HealthLeaders Media, January 13, 2010
Proposals clash on states' role in health plans
New York Times, January 14, 2010
Connecticut Health Care Advocate gets $6.7 million back from insurers
Hartford Courant, January 14, 2010

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Audio Feature
Blue Shield Reaches Patients Through Portal

Jim Orchison, director of network design and programs for Blue Shield of California, talks about the insurer's new Internet portal called Patient Ally, which was developed by Office Ally. [Sponsored by Emdeon] [Listen Now]
Audio Feature
What's Missing in Health Reform?

Kansas Insurance Commissioner Sandy Praeger talks about the current health reform plans, what they would mean to health insurers, and what is missing from the proposals. Praeger is also chair of the National Association of Insurance Commissioners' Health and Managed Care Committee. [Sponsored by Emdeon] [Listen Now]
Health Plan Forum
Next-Generation Analytics that Drive Better Clinical Care Decisions

Health plans are urgently seeking ways to improve quality while controlling costs. We are seeing next-generation analytics that can draw from multiple sources to meet some of our greatest challenges. We are moving into an era of information that is specific and current. Newer technologies integrate lab values and point-of-care clinical information?including data from electronic health records, writes Douglas M. Moeller, MD, medical director at McKesson Health Solutions. [Read Now]
From HealthLeaders Magazine
The Other Challenges for Health Plans

The year 2009 saw health insurers in the crosshairs in Washington as health reform made its way through the Capitol Hill sausage grinder. Health insurance executives understandably were focused on Congress and how health reform would affect their businesses, most notably reform that would shift insurers away from a risk-management business by requiring insurers to accept everyone?regardless of preexisting conditions. But while they focus on Washington, insurers face other immediate challenges. Here are issues insurers face in 2010 and how they can overcome them. [Read More]
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