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Pay Patients Without Overpaying
Elyas Bakhtiari, for HealthLeaders Media

If you want physicians as a group to focus more on quality, pay them based on performance. If you want employees to quit smoking or follow routine wellness programs, give them cash incentives. If you want to remind patients to take their medication, pay them with a lottery. Sometimes it seems that paying cash is the only way to get anyone to do anything, even when inaction is potentially life threatening. [Read More]
  June 16, 2010

Editor's Picks
Seven Largest Insurers Incorrectly Pay One in Five Claims, Says AMA
Health insurers don't correctly process one in five medical claims, causing delays and adding more work, hassle, and cost to the healthcare system, according to a new American Medical Association scorecard. The most accurately-paying insurer was Coventry Health Care Inc., which had an 88.41% correct claims processing score. Anthem Blue Cross Blue Shield came out last, with an accuracy rating of 73.98%. [Read More]
New rules on changes to health benefits
The White House will issue new rules that strongly discourage employers from cutting health insurance benefits or increasing the costs of coverage to employees, administration officials say. The rules limit the changes that employers can make if they want to be exempt from certain provisions of the healthcare law passed by Congress in March. Many employers want the exemption because it allows them to keep their existing health plans intact with a minimum of changes. [Read More]
Insurers Defend Medicare Advantage in Wake of HHS Warning
The deadline for 2011 Medicare Advantage carrier bids provided another flash point in the ongoing clash between insurers and the government, as cuts to the MA program—as well as the possibility of higher rates for seniors—inch closer to enactment. Although the $136 billion in cuts over 10 years won't kick in until 2012, the MA 2011 payment rates will be frozen at 2010 levels. Even though medical expenses are expected to continue rising, HHS Secretary Kathleen Sebelius said in a letter to four insurers that "Medicare Advantage plans [should] offer the same level of choices at affordable cost-sharing and premiums next year that they do this year." [Read More]
New York Enacts Health Insurance Law With New Medical Loss Ratio
In what may become part of a trend among the states, New York Gov. David Paterson signed into law a bill that reinstates the New York State Insurance Department's authority to review and approve health insurance premium increases before they take effect and adds a medical loss ratio that insurers must meet. The new law raises the medical loss ratio from 75% to 82% for small businesses and from 80% to 82% for individuals. [Read More]

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Managed Care Headlines
PWC Projects a 9% Bump in Employers' Medical Costs, Greater Employee Cost-shifting in 2011
John Commins, for HealthLeaders Media, June 15, 2010
Horizon Blue Cross officials questioned about executive pay
Philadelphia Inquirer, June 15, 2010
Massachusetts asks to oversee three insurers
Boston Globe, June 11, 2010
Virginia Says It Can Challenge Federal Government over Mandate
Janice Simmons, for HealthLeaders Media, June 9, 2010

Webcasts/Audio conferences
June 23: Cardiovascular Service Lines Strategies
July 15: A Better Way Than Pay For Call Coverage
July 22: Marketing to Physicians: Increase Sales Success Through Measurement and Tracking

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Audio Feature
Preventing Missed Revenue Opportunities

Robert Sutton, partner at Chadds Ford, PA-based IMA Consulting, discusses tips for preventing missed revenue opportunities due to third-party payer contractual underpayment. [Sponsored by Emdeon] [Listen Now]
Health Plan Forum
Exemptions Spelled Out For Healthcare Reform Law

Final interim rules issued by the departments of Health and Human Services, Treasury, and Labor on Monday specify when group health plans will be exempted—or "grandfathered in"—when complying with the new healthcare reform requirements. Under the interim rules, all health plans—whether or not they are grandfathered plans—must provide specific benefits to their customers for plan years starting on or after Sept. 23, 2010. [Read Now]
From HealthLeaders Magazine
Preparing for Parity

The national mental health parity law is expected to serve millions of Americans, but there is much debate about how it will be carried out. [Read More]
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Resources From HCPro

Learn how increased collaboration between providers and managed care payers has the potential to reduce costs, improve processes, and enhance patient care.
Discover how to integrate wellness into your DM programs.
Read about practical strategies for maximizing the effectiveness of health and disease management programs.
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