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Is HHS Compromising with Insurers?
Jeff Elliott, HealthLeaders Media

Last week HHS attempted to stem the recent trend among healthcare payers to drop "child only" health plans by clarifying policies that aren't explicitly forbidden by the Affordable Care Act. The letter from Department of Health and Human Services chief Kathleen Sebelius to the National Association of Insurance Commissioners pulls the two slightly closer, but both are still at the mercy of the states.[Read More]
cora nucci
  October 20, 2010

Editor's Picks
DOJ Files Antitrust Suit Against BCBS Michigan
The long arm of the Department of Justice came down from Washington and filed a civil antitrust lawsuit Monday against Blue Cross Blue Shield of Michigan, alleging that the insurer's most favored nation pacts with hospitals across the state raise prices, stifle competition from other insurers, and discourage discounts. As a result of these MFN pacts, Michigan consumers pay higher prices for healthcare services and health insurance, said Christine Varney, assistant attorney general in charge of DOJ's Antitrust Division. A BCBSM corporate communications executive says the suit is "without merit." [Read More]
Health Plan Cost Poor Indicator of Value
With extensive comparisons of health plans' performance and utilization of resources, the National Committee for Quality Assurance has determined that higher spending on healthcare doesn't necessarily translate into better quality care. More care is not always linked to better results, confirming that the saying 'you get what you pay for' does not apply to healthcare," the nonprofit accreditation firm said in a statement. [Read More]
Medicaid Status, Race Linked with Hospital Readmissions
As payers, providers, and policymakers look for ways to address hospital readmissions, research published Wednesday in the Journal of Hospital Medicine offers insight into possible risk factors. Both being African-American and being on Medicaid were associated with readmission, after adjustment for other variables. Of the clinical factors, high-risk medications and several comorbidities (congestive heart failure, renal disease, cancer) were associated with readmission. The study authors call for hospitalists, "at the nexus of the discharge process" to lead efforts to reduce readmissions. [Read More]
Intelligence Report: Patient Experience — Help Wanted
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.

Managed Care Headlines
Insurers test cancer pay systems
The New York Times, October 20, 2010
Bay Area's hospital costs rising to top in California, but superior care isn't guaranteed
San Jose Mercury News, October 18, 2010
Medicare faulted on surgery evaluation
The Wall Street Journal, October 19, 2010
Citing healthcare law, Boeing pares employee plan
AP, October 19, 2010
Kids' Medicaid-covered flu shots put docs at a loss: study
HealthDay News, October 19, 2010
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From HealthLeaders Magazine
Your Move:
Hospitals are Predicting, Adapting to Change

The business models that will emerge in the era of healthcare reform are still unclear, but leading hospitals and health systems are already positioning themselves to adapt when they do come into focus. They're taking the first steps toward becoming accountable care organizations even before anyone knows for sure what an ACO will look like—or even if they'll ever come to fruition. [Read More]
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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]
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