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Sebelius Talks Tough to Insurers, Needs to Take Action
Cora Nucci, Senior Online Editor for HealthLeaders Media

Insurers that "unjustifiably" raise premium rates may be deemed ineligible to participate in health insurance exchanges come 2014, says Department of Health and Human Services Secretary Kathleen Sebelius. The insurance industry is an easy target for rising healthcare costs and Sebelius is piling on. Whether she can bend the industry to her will and clamp down on rate hikes remains to be seen.[Read More]
cora nucci
  September 15, 2010

Editor's Picks
Berwick Calls on Insurers to Work With CMS
In his first major speech since becoming head of the Centers for Medicare & Medicaid Services, Donald Berwick, MD, on Monday spoke bluntly to attendees at an America's Health Insurance Plans conference in Washington. "CMS can't do this alone. Government can't do this alone. We will either build a new healthcare system for our country together?or we're not going to build it at all," Berwick said." He urged the insurance industry to work with government to advance the Obama administration's healthcare reform goals. [Read More]
Sebelius Cautions Insurers on Rate Hikes
In a sternly worded message to health insurers, Health and Human Services Secretary Kathleen Sebelius said last week that the federal government will not "stand idly by as insurers blame their premium hikes and increased profits" on changes related to the new healthcare reform legislation. Sebelius said in her letter to Karen Ignagni, president and CEO of America's Health Insurance Plans that HHS will be keeping track of insurers that sharply raise their 2011 premiums. [Read More]
CMA Sues Blue Shield Over Physician Rating System
The California Medical Association says it has filed a class action lawsuit against Blue Shield for imposing an unfair and potentially harmful rating system, the Blue Ribbon Recognition Program. The scorecard in question involves Blue Shield's posting of blue ribbons on its website next to the names of doctors who have met certain care criteria. But the CMA lawsuit says the scoring system is flawed. [Read More]
Insurers Try Incentives to Improve Medication Adherence
Estimates put the percentage of those who don't comply with prescription instructions somewhere between one-third and one-half. The overall cost of poor adherence, measured in otherwise avoidable medical spending, may account for as much as 13% of total healthcare expenditures, according to one estimate. Now insurers and others are trying to figure out what incentives—including financial rewards—may improve medication adherence and, in the long run, improve quality and reduce costs. [Read More]
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Managed Care Headlines
NAIC: Health Reform Provisions Unclear to Most Americans
John Commins, for HealthLeaders Media, September 15, 2010
Judge sets December 16 hearing on healthcare suit
Reuters, September 15, 2010
Health plan won't fuel big spending, report says
The New York Times, September 9, 2010
CBO: Obesity Pumps Up Healthcare Costs
Janice Simmons, for HealthLeaders Media, September 14, 2010
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Audio Feature
Payment Model Innovation: Sharing the Rewards of a Pay-For-Performance Program

Neal Peyser, Managing Director FTI Healthcare discusses the creation of payment incentives for better collaboration between hospitals and their medical staff. He describes how one facility was able to tap incentive payments from a commercial payer that were based on meeting quality and efficiency metrics, and share them with physicians. [Sponsored by FTI Healthcare] [Listen Now]