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Risk Adjustment Key to Competition Within Health Insurance Exchanges
Cora Nucci, Senior Online Editor for HealthLeaders Media

Health plans that have long been incented to compete on risk selection—vying for healthy enrollees and eschewing the sick—are bracing for new rules that will turn their offerings into commodities with buying decisions hinging on price above all else.[Read More]
August 04, 2010  

Editor's Picks
How to Address Next-Gen Payment, Claims Management Systems
Contracting processes and claims systems are being pushed beyond their stated purpose and designs. Many health plans use legacy systems that were implemented during simpler eras, when payors dealt with one claim at a time. Even some updated systems lack the flexibility to handle changes to standard plan policies, enforce complex new policies, and make appropriate connections between separate claims that should be grouped. Plans must look for systems with the capabilities to look across claims and providers. [Read More]
Hospitalists Unaware of Treatment Costs for Inpatients
How much does an overnight stay in the ICU cost? $750? $6,000? Haven't got a clue? Many hospitalists don't know either. The cost of an ICU bed per night is $1,107, according to a recent study of two Washington hospitals. The $750-$6,000 range was what physicians at those facilities guessed. Even though proponents of the hospitalist model have long claimed that hospitalists cut costs, hospitalists are unaware of the actual costs of care to inpatients, a study in the Journal of Hospital Medicineshows. [Read More]
The Challenge of Measuring Healthcare Value
Last month the nation's largest health insurers received a letter from the American Medical Association and 46 state medical societies sharply criticizing the accuracy and reliability of the cost-profiling mechanisms that many payers use to rate and tier physicians. For insurers, the simple task is to reward physicians for efficient and high-quality care. But the AMA and others not only think that the formulas for measuring efficiency are too complicated, they think the formulas don't actually accomplish their goal very well. [Read More]
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Managed Care Headlines
New health law has stung insurers focusing on election
Bloomburg, August 04, 2010
Judge: VA's healthcare reform challenge can continue
Richmond Times-Dispatch, August 04, 2010
Major leadership changes under way at Omnicare
Cincinnati Enquirer, August 03, 2010
Tufts Health will rein in rate increases
The Boston Globe, August 03, 2010
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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]
From HealthLeaders Magazine
Nursing's Growing Role

The new focus is on nurse-led care delivery systems and harnessing the economic power of nursing. [Read More]
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