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Health Insurance Reform May Be Far From Over
Elyas Bakhtiari, for HealthLeaders Media

After a year of debate and lobbying and speculation, the passage of the Patient Protection and Affordable Care Act last month seemed like a definitive period at the end of long and rambling sentence. But for the health insurance industry, it might have just been a comma, bringing only a brief pause in the pursuit of industry reforms, rather than its end. [Read More]
  April 28, 2010

Editor's Picks
CMS Actuary: Reform Law Would Push Spending Up By 1%
National health spending would increase by $311 billion—up by about 1%, from 2010 through 2019 under the new healthcare reform legislation, according to a report from the Centers for Medicare and Medicaid Services Chief Actuary Rick Foster. Most of that reflects expanded coverage, as spending per person is expected to decline. Perhaps most concerning was Foster's warning that Medicare productivity adjustments could become unattainable and that 15% of hospitals and other Medicare Part A providers could become unprofitable, causing them to stop treating Medicare beneficiaries. [Read More]
Director resigns at WellCare Health, highlighting questionable accounting
A prominent director at WellCare Health Plans Inc. has resigned and raised questions about accounting practices at the Medicare and Medicaid company. Regina Herzlinger, the head of the board's audit committee and a professor of business administration at Harvard Business School, said internal audits found WellCare overbilled the Illinois Medicaid program by $1 million in 2009 and potentially overcharged states for almost $500,000 worth of maternity care. Additionally, the company ran afoul of Georgia's requirements that it account for each patient visit for which it paid providers, resulting in a $610,000 fine, she said. [Read More]
WellPoint, Sebelius Spar Over Breast Cancer Rescissions
A Reuters article claiming that WellPoint subsidiaries used a computer algorithm to cancel the insurance policies of breast cancer patients sparked a rebuke from the Secretary of Health and Human Services last Friday. WellPoint quickly fired back with claims that the article was inaccurate, and at least one of the case studies used in the article was retracted because the person wasn't a WellPoint customer. Still, the sharp rebuke may indicate how aggressively HHS Secretary Kathleen Sebelius plans to enforce the ban on rescissions that passed in the recent reform package. [Read More]
Regulator gives insurers good news
A first look at how a key provision in the federal health overhaul could be implemented suggests that insurers' profits won't take the hit that the industry had feared, the Wall Street Journal reports. At issue is the medical-loss ratio, or MLR, which under the new law requires insurers in the large-group market to spend 85% of the premiums they collect on medical expenses, as opposed to administrative expenses and profit-taking. Rick Diamond, a Maine actuary tasked with helping the National Association of Insurance Commissioners define MLR, wrote in a draft document posted on the commission's Web site that most insurers can meet the loss-ratio requirements of the new law. [Read More]
Looking for Strong Leadership Teams
The April 30 deadline is fast approaching to enter the seventh annual Top Leadership Teams in Healthcare Awards—a program that celebrates stories of great healthcare leadership in hospitals, health plans, and medical group practices. There are five categories: large hospitals and health systems (500 or more licensed beds); community and mid-sized hospitals (100 to 499 licensed beds); small hospitals (fewer than 100 licensed beds); health plans (state, regional, and national); and medical group practices (physician-owned, single- or multi-specialty groups employing 25 or more physicians). Previous winners in the health plan category include Independent Health in Williamsville, NY, and Harvard Pilgrim in Boston. [Learn More]
Managed Care Headlines
Medicare Tries to Reduce Fraud and Waste, But Causes Backlog in Payments
Cheryl Clark, for HealthLeaders Media, April 28, 2010
With Pressure from HHS and Congress, Insurers Address Rescission Policies
Janice Simmons, for HealthLeaders Media, April 28, 2010
Bogus 'ObamaCare' health plans offered in door-to-door scam
Hartford Courant, April 28, 2010
WellPoint and Blue Shield of California to stop dropping sick policyholders
Los Angeles Times, April 28, 2010

Webcasts/Audio conferences
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May 19: Five Proven Steps to Improve Patient Satisfaction Scores
June 2: Seamless Systems of Care: Better Alignment, Coordination, and Outcomes

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Audio Feature
The State of HSAs

Martin Trussell, senior vice president of business development at First Horizon Msaver, a leading provider of health savings accounts, talks about the state of HSAs and how health reform will affect them. [Sponsored by Emdeon] [Listen Now]
Audio Feature
Strategies for Reducing Drug Spending

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Health Plan Forum
Senate Panel: Insurers Spending Too Much on Overhead

Health insurers' medical loss ratios in many markets are still falling far below the minimum levels of what they will need to spend under health reform signed into law last month by President Obama. These new medical-loss ratio floors go into effect on Jan. 1, 2011, according to a new report released by the chairman of the Senate Commerce, Science, and Transportation Committee. [Read Now]
From HealthLeaders Magazine
Putting the Consumer in Charge

The relationship between insurers and their members has been traditionally cool—at best. On the positive side, consumers see health insurers as the faceless entity that pays for their care and, more negatively, the companies that reject paying for care. The consumerism movement in benefit design has shifted more costs and decision-making to individuals. By 2020, members will have even greater responsibility for their healthcare. Members will need to become better healthcare consumers. Health insurers see the transformation coming, and leaders are preparing. [Read More]
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