HealthLeaders Media Health Plan Insider - December 1, 2010 | Health Insurers Gird for MLR Changes View as a Webpage | Subscribe for Free
Health Insurers Gird for MLR Changes
Jeff Elliott, HealthLeaders Media

New rules require health plans to apply between 80% and 85% of premiums directly to patient care or quality improvement initiatives. Payers that don't comply with federally mandated medical loss ratios will be forced to provide rebates to their customers. Now the quibbling over to calculate the ratio begins.[Read More]
cora nucci
  December 1, 2010

Editor's Picks
Top 10 HealthLeaders News Stories of 2010
Healthcare reform, medical errors, and nursing workforce issues have dominated the headlines in 2010. We run down our most popular news stories of the year in case you missed them, or just want to have another look. [Read More]
House Vote Delays SGR Cuts
With just a day to spare, the House of Representatives has avoided a Medicare meltdown by approving a one-month delay in its scheduled 23% cut to physicians' Medicare fees as defined by the sustainable growth rate formula. The Senate took similar action earlier this month. The American Hospital Association called the move by Congress "a good first step." And The American College of Physicians released a video featuring physicians, in their own words, urging Congress to make the doc fix. [Read More]
OIG: Medicaid Paid $6.2B for Unapproved Drugs
More than a third of the prescription drugs paid for by Medicaid in 2008 were not on a list of approved drugs in National Drug Code Directory and may have accounted for $6.2 billion of the $24 billion that Medicaid spent on prescription drugs that year, according to an audit by the Department of Health and Human Services' Office of Inspector General. [Read More]
CA Slaps Health Plans for Delaying Payments
California regulators have fined the state's seven largest health plans $4.85 million after finding widespread patterns of unfairly processing, delaying, and denying physician and hospital reimbursement claims for patient care. As a result of the penalties, health plans throughout the state will soon be repaying "tens of millions" of dollars more to providers they owe—about 70% to hospitals and 30% to doctors—as health plans make restitution for their bad practices, says California Department of Managed Health Care Director Cindy Ehnes. [Read More]
Intelligence Report: Hospital Mergers & Acquisitions
Brand-new research shows that 64% of healthcare leaders expect an increase in M&A activity between acute care hospitals and both diagnostic imaging and ambulatory surgery centers. As the transaction tide continues to rise, the newest HealthLeaders Media Intelligence Report, Hospital Mergers & Acquisitions: Opportunities and Challenges, reveals key insights to help keep you afloat. [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
10% of Family Docs Mull Shuttering Over Medicare Cuts
HealthLeaders Media, November 29, 2010

Hospital Execs, Get Strategic About Capital Expenditures
HealthLeaders Media, November 29, 2010

Florida Physician to Pay $22.6M to Settle Medicare Fraud Claims
HealthLeaders Media, November 29, 2010

UnitedHealth predicts lower profit for 2011
The Star Tribune, December 1, 2010

Senate widens its probe of bare-bones health plans
The Wall Street Journal, November 30, 2010

Medicare Advantage provision going smoothly
The Washington Post, November 30, 2010

Some doctors asking Medicare patients to switch plans
The Seattle Times, November 29, 2010

Blue Cross Blue Shield of Michigan accused of pocketing millions
Free Press, November 24, 2010

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From HealthLeaders Magazine
The Physician's Place in the ACO

Development of accountable care organizations may be critical to holding down costs and improving quality. But how will doctors' roles change? [Read More]
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