HealthLeaders Media Health Plan Insider - October 27, 2010 | Could Health Plans Derail ACOs? View as a Webpage | Subscribe for Free
Could Health Plans Derail ACOs?
Jeff Elliott, HealthLeaders Media

The reality is that everyone will protect their own interests, which has health plans knocking on doors in Washington, making sure federal agencies are aware that collaboration among already powerful healthcare providers under the ACO model also includes the risk collusion.[Read More]
cora nucci
  October 27, 2010

Editor's Picks
Cutting Costs With Care Gap Alerts
Health plans intending to deliver better care and curb provider costs are using a simple clinical messaging tool—care gap alerts—that aims to do both. The alerts, triggered by a patient's office visit and generated electronically, notify providers on the spot if a patient is due and eligible for services. [Read More]
Citing SGR Cuts, Physicians Mull Dropping Medicare Patients
Two of three medical practices surveyed by MGMA say they will either limit the number of new Medicare patients they accept or stop seeing Medicare patients altogether if Congress does not block reimbursement cuts stemming from the sustainable growth rate formula. [Read More]
No End In Sight to Rising Healthcare Costs
Providers say they're working to decrease healthcare costs, but the bills keep mounting. There are more than a few culprits here: the economy, hospitals, insurers, employers, even physicians. High-deductible health plans aren't the answer; people don't shop around for bargains when they're sick. It all adds up to a dim financial future for patients and providers. [Read More]
Intelligence Report: Patient Experience — Help Wanted
While 72% of senior healthcare leaders say that patient experience has been a priority in the past year, only 1 of 8 CEOs has primary responsibility for it. Our exclusive, original research and analysis examines this paradox and delves into the realm of patient experience and its challenges, including why healthcare leaders report lack of success in achieving the kind of patient experience they need to provide. [Read More]
HealthLeaders Media Rounds: Building Accountable Care Organizations
Hospitals and physicians are working hurriedly to build systems of care that reward quality, outcomes, and high-value care—the ingredients of the accountable care organization. Innovative healthcare leaders like Carilion Clinic, Norton Healthcare, and Sinai Health System are getting ready now for the future of healthcare system delivery. Join us on Dec. 9 from Carilion Clinic and share the lessons these leaders have learned. [Register today]

Managed Care Headlines
State regulators approve federal guidelines for health insurance
The Los Angeles Times, October 22, 2010
States' Medicaid Funding Falls $1.7B Short
HealthLeaders Media, October 20, 2010
Health insurers raise rates, while increasing reserves and salaries, October 25, 2010
Health insurer HealthMarkets sued by L.A. city attorney over 'junk insurance'
The Los Angeles Times, October 21, 2010
Aetna's Williams to retire, Bertolini to be new chief at Health Insurer
Bloomberg, October 21, 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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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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