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The Nightmare of Health Insurance Bureaucracy
Joe Cantlupe, Senior Editor-Managed Care

Douglas Arnold, CEO of Medical Professional Services in Middletown, CT, a clinically integrated independent practice association of 400 physicians, in a speech before the American Medical Association talked about the "daunting" and "administrative nightmare" of the health plan bureaucracy. Health insurance companies can learn from Arnold and the Connecticut program to understand that they will have to remove barriers if the two sides are to work together. [Read More]
  March 10, 2010

Editor's Picks
Insurers to Sebelius: Stop Vilifying Us
Citing an analysis by Goldman Sachs that competition in the insurance market is so weak that insurance companies can continue to raise rates even if it means losing customers, HHS Secretary Kathleen Sebelius asked five health plan leaders to "publicly justify" their proposed health insurance premium increases. Sebelius' request was similar to what she made after a White House meeting with healthcare leaders last Thursday. America's Health Insurance Plans, the industry lobby, issued a sharp rebuke of Sebelius' comment, but also did not respond specifically to her request. "The men and women are working hard every day to make the healthcare system better and they do not deserve to be vilified for political purposes," says Robert Zirkelbach, press secretary for AHIP. [Read More]
$4 Billion in Fraudulent Medicare Charges Found in 2009
The Office of Inspector General recovered $4 billion in fraudulent Medicare charges last year, but that sum is "just the tip of the iceberg" in the amount of corrupt practices that are overcharging taxpayers, Daniel Levinson, the agency's chief, testified Thursday. "More disturbing, even if the rate of fraud remains constant, as healthcare expenditures continue to rise, the financial impact of healthcare fraud will continue to increase," he said. His talk was indicative of the increased emphasis the Obama administration places on reigning in illegal, dishonest, and wasteful healthcare practices not just among providers, but also in the system that allows wasteful spending to continue. [Read More]
Insurers, White House Don't Agree on Who's To Blame for Rising Health Costs
Leaders of the nation's four largest health plans told HHS Secretary Kathleen Sebelius at a White House meeting that they share a "common purpose" with her to improve the nation's healthcare system, but they defended their proposed double-digit rate hike in the individual market. The meeting was seen as cordial and somewhat productive, but essentially broke no new ground, with both sides sticking to their months' long talking points: The administration saying the insurance premiums are too high and the insurers blaming health-related costs for the increases. [Read More]
Many Flaws in Medicare Part D's Fraud Prevention, Says HHS Inspector
Though five years into the Medicare Part D drug program, CMS' efforts to root out fraud and waste are still "limited in scope and may not sufficiently protect the program," a federal inspector told Congress. "Lack of effective oversight exposes the Part D program and Medicare beneficiaries to a wide range of fraud, waste, and abuse, including inappropriate billings, payments for excluded drugs, drug diversion, improper bid submissions, excessive premiums, and illegal marketing schemes," Robert Vito, a regional inspector general for HHS, told the Senate Committee on Homeland Security and Governmental Affairs. [Read More]
Obama Backs Reconciliation Without Actually Saying the Word
The most notable message presented in President Obama's White House healthcare reform speech is that the next step for Congress would be to seek passage of legislation using simple majority voting—in other words, the reconciliation process. However, during his 15-minutes speech in front of many healthcare professionals, he never actually used the controversial "R" word. [Read More]
Managed Care Headlines
Connecticut AG reports Anthem's anti-competitive contracts to top Obama health official
Hartford Courant, March 9, 2010
Under Pressure from Justice Department, Michigan Insurers Spike Merger Plans
Joe Cantlupe, for HealthLeaders Media, March 9, 2010
CMS Drops Fox Insurance from Medicare Part D
Les Masterson, for HealthLeaders Media, March 10, 2010
Suit filed over end of General Assistance Medical Care in Minnesota
Minneapolis Star Tribune, March 5, 2010
BlueCross BlueShield of Tennessee expands doctor, treatment comparison tool
The Tennessean, March 4, 2010
Virginia health bill could foil Obama proposal
Boston Globe, March 8, 2010
Massachusetts health insurers seeking rate hike
Boston Globe, March 8, 2010
Business buys ads vs. health overhaul
Wall Street Journal, March 10, 2010

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State of Nonprofit Healthcare

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John Bahl, head of member and consumer online strategy and operations at Aetna, discusses the health insurer's redesigned Web site and how it's bringing many unique users to the site. [Sponsored by Emdeon] [Listen Now]
Health Plan Forum
Voice Personality is a Powerful Lever to Motivate Health Behavior

In healthcare, individuals are educated and supported in the decisions they make about their health through communications. This article highlights a recent study of the impact of voice in healthcare communications and how individuals perceive voice as it relates to health messaging. [Read Now]
From HealthLeaders Magazine
What Will Be the Payment Model in 2020?

Don't expect one payment model in 2020. There will be a hodgepodge of global payments, bundled payments, quality payments, and yes, even fee for service. But one commonality among all forms of payment will be greater collaboration between health insurance companies and physicians and hospitals. [Read More]
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