HCPro Health Plan Insider - October 6, 2010 | ACO, MLR Specters Haunt Providers, Employers View as a Webpage | Subscribe for Free
ACO, MLR Specters Haunt Providers, Employers
Cora Nucci, Senior Online Editor for HealthLeaders Media

The Patient Protection and Affordable Care Act is freighted with anxiety-inducing provisions that are eliciting angst in all quarters. Providers fear that participating in accountable care organizations will turn them into criminals. Employers, meanwhile, fear they'll be crushed by onerous medical loss ratios.[Read More]
cora nucci
  October 6, 2010

Editor's Picks
FTC to Explore Antitrust Waivers for ACOs
The Federal Trade Commission says it may waive antitrust laws that could hinder the creation of effective accountable care organizations by doctors, hospitals, and other medical professionals. The Affordable Care Act gives HHS Secretary Kathleen Sebelius the authority to waive fraud and abuse laws "as necessary," Health and Human Services Inspector General Daniel R. Levinson said. The remarks came Tuesday at a public FTC/Centers for Medicare & Medicaid Service Workshop on ACOs held in Baltimore. [Read More]
8 HIE Implementation Barriers Detailed
A report from The Commonwealth Fund identifies eight of the most difficult issues state and federal policymakers will face as they work to implement health insurance exchanges. Topping the list are governance, adverse selection, and making self-funded plans compatible with exchanges. State HIEs, mandated by the Patient Protection and Affordable Care Act, become operational in 2014; in 2017, states will be permitted to open them to large employers. [Read More]
CA Governor Signs Radiation Overdose Bill into Law
In the first law of its kind, California Gov. Arnold Schwarzenegger has signed a bill that will require health facilities to notify the state Department of Public Health any time a patient receives a radiation dose in an imaging scan that exceeds 20% of what was intended. Effective July 1, 2012, the law requires that CT scanners receive accreditation by an organization approved by the Centers for Medicare and Medicaid Services by Jan. 1, 2013. [Read More]
Intelligence Report: Physician Alignment in an Era of Change
Hospitals are looking to employ more physicians and buy more medical groups; at the same time, hospitals are receiving an increase in inquiries from physician groups for employment. But this marriage is not without trepidation. Elements of payment reform are expected to put considerable strain on hospital-physician relations. In this exclusive report based on original research and analysis, we find out what 258 healthcare executives and clinical leaders think about these topics and more. [Read More]

Register Today for Lead Transformation: Accelerate Value, Quality, and Coordination
Join us October 21, live or virtually, for this complimentary, exclusive half-day leadership event that will bring leaders from top healthcare organizations to explore real paths to take today toward accountable care structures and define what medical home and patient-centered care mean for your healthcare organization. Recognized leaders and peer experts will be featured from: Texas Health Presbyterian Hospital Dallas, Columbus Regional Hospital, Baptist Health System, Chenango Memorial Hospital, Network Health, Crystal Run Healthcare, Moffitt Cancer Center, Novant Health, and GE Healthcare, Americas. This event takes place October 21, 8:30 am—12:30 pm (CST) at The Fairmont in Dallas, Texas. To register call 800/753-0131 or click here.
Sponsored Headlines
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Managed Care Headlines
Opinion: Healthcare's lost weekend
The New York Times, October 5, 2010
Federal agency flexible on McDonald's health plan
The Wall Street Journal, October 1, 2010
3M to end retirees' health plan
Minneapolis Star Tribune, October 5, 2010
HHS Awards $49 Million to States for HIEs
John Commins, for HealthLeaders Media, October 4, 2010
3 units of Aetna pay $850,000 fine to NY
insurancenewsnet.com, October 6, 2010
Blue Cross tests 'medical home' model
Omaha World-Herald, October 1, 2010
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From HealthLeaders Magazine
Strategies for Hospital C-suite Organization

We all know who holds the ultimate power in the C-suite, but what's the ideal balance of power among its other leaders? How do you get your top lieutenants working together as a team rather than as little tyrants lording over their healthcare fiefdoms? [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.
Learn how to educate and engage members.

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]
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