HealthLeaders Media Health Plan Insider - November 10, 2010 | Healthcare Reform: Two Out of Three Ain't Bad View as a Webpage | Subscribe for Free
Healthcare Reform: Two Out of Three Ain't Bad
Jeff Elliott, HealthLeaders Media

The feds told us healthcare reform was about creating a high-quality, affordable delivery system for every American within four years. Not only is that a lofty goal, it's impossibility by project management standards.[Read More]
cora nucci
  November 10, 2010

Editor's Picks
Medication Adherence Increases with V-BID
Value-based insurance design is intended to align patients' out-of-pocket costs, including co-pays and premiums, with the value of the health service. Lower insurance copays for high-value medications lead to greater adherence, study in Health Affairs shows. [Read More]
Slashing Medicare Reimbursements Curbs Treatment Overuse
Cuts in Medicare reimbursements for services that have mixed applications can reduce unnecessary use without reducing effective use in cases that are warranted, researchers find. Prior to the cuts, Medicare reimbursement for ADT was set at 95% of the average wholesale price of the drug with the average practice securing the drug for 82% of the average wholesale price, creating significant margins for many providers. [Read More]
Providers Prep for Medicaid RAC Proposed Rule
The release by the Centers for Medicare & Medicaid Services of the proposed rule for Medicaid recovery audit contractors sets the stage for an April 2011 implementation date. Providers now need to tighten up their processes for accurate coding. The initiative is designed to identify waste, fraud, and abuse in the healthcare system by reducing improper payments. [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 and Norton Healthcare 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]
Breakthroughs Report: Future Healthcare and Collaboration
Explore strategies to accelerate the drive toward more cost-efficient and quality healthcare. In this new HealthLeaders Media Breakthroughs report, leading hospital systems—Virtua, Crouse Hospital, Heartland Health, and The Chester County Hospital—share insights and lessons learned. [Read More]

Managed Care Headlines
Nearly 59 million lack health insurance: CDC
Reuters, November 10, 2010
Ky. auditor: Medicaid provider oversight needed
Bloomberg Businessweek, November 10, 2010
Opinion: How Medicare killed the family doctor
The Wall Street Journal, November 8, 2010
AMA: Swift Congressional Action on SGR 'Critical'
HealthLeaders Media, November 9, 2010
Medicare Cheat Used Homeless in Fraud Scheme
HealthLeaders Media, October 28, 2010
Medicare's CMO speaks about dialysis
NPR, November 10, 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
Will DOJ Quash Insurers' Most Favored Nation Clauses?

A recent Department of Justice lawsuit threatens the "most favored nation" clauses common to many insurer contracts with healthcare providers. Attorney Dale Grimes of Bass, Berry & Sims discusses the potential upheaval associated with this contracting mainstay. [Sponsored by Emdeon] [Listen Now]