HealthLeaders Media Health Plan Insider - December 8, 2010 | Insurers vs. Hospitals: Who Has the Upper Hand? View as a Webpage | Subscribe for Free
Insurers vs. Hospitals: Who Has the Upper Hand?
Jeff Elliott, HealthLeaders Media

A study by the Center for Studying Health System Change finds that hospitals are successfully negotiating higher-than-competitive prices with insurers. So much so, that the prices are an anomaly compared with other industries in competitive markets, according to the report. Hogwash, hospitals say. What's really going on here? [Read More]
  December 8, 2010

Editor's Picks
Medicaid Drug Programs Could Save $30B by Dropping FFS, Study Claims
State Medicaid pharmacy programs could save more than $30 billion over the next decade if they switched from fee-for-service programs to the more efficient approaches used by Medicare Part D plans, Medicaid managed care organizations, and commercial plans, claims a study from The Lewin Group. Lewin says its findings challenge the assumption that Medicaid pharmacy programs can reduce costs only by cutting benefits, limiting eligibility, demanding deeper manufacturer rebates, or paying drugstores higher dispensing fees in exchange for more pricing transparency. [Read More]
HL20: Elliott Fisher—Data-Driven ACO Visionary
Dartmouth Medical School professor of medicine Elliott Fisher MD, MPH, is profiled in HealthLeaders's annual list of 20 People Who Make Healthcare Better. When asked where he sees himself in 10 years, Fisher, commonly hailed as the father of accountable care organizations, is self effacing. "I might be in hiding because ACOs failed," he jokes. But when it comes to improving the healthcare system in the United States, Fisher trades facetiousness for data. [Read More]
Why Geographic Variation in Medicare Spending Matters
Medicare spending per capita varies almost threefold between the lowest and highest spending regions in the nation, research shows. The reasons why are debatable, but the implication for hospitals is clear: the government is taking steps to adjust the Medicare system to account for those variations. And the bottom line is this: Hospitals are expected to take the lead on developing the process and infrastructure necessary to receive and distribute bundled payments from Medicare. [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 HealthLeaders Media Intelligence Report, Hospital Mergers & Acquisitions: Opportunities and Challenges, reveals key insights to help keep you afloat. [Read More]
Webcast: Tactics to Measure Financial ROI for Marketing Efforts
Proving marketing ROI is both critical to do, yet often hard to do. In this economic and competitive environment, the stakes are high-you need to show the efficacy of your marketing dollars through a commitment to measuring your efforts beyond brand awareness. Join HealthLeaders Media on December 13 for this 90-minute Webcast and Q&A to get specific how-to's on demonstrable marketing efficacy with case studies from Chester County Hospital and Fairview Health Services. [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
Arizona Medicaid cuts seen as a sign of the times
The New York Times, December 7, 2010

Aetna to Pay $500M for Medicity
John Commins, for HealthLeaders Media, December 7, 2010

Family Health Plan Premiums 'Increasingly Unaffordable'
Jeff Elliott, for HealthLeaders Media, December 6, 2010

Cleveland Clinic to cut charity care for some
Dayton Daily News, December 7, 2010

RI hospital group sues over insurance rules
The Boston Globe, December 2, 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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