HealthLeaders Media Health Plan Insider - July 20, 2011 | IPAB Pushback Centers on Power, Politics View as a Webpage | Subscribe for Free
IPAB Pushback Centers on Power, Politics
Margaret Dick Tocknell, Senior Editor

As the focus of two recent congressional hearings, the Independent Payment Advisory Board, charged with controlling Medicare costs, is generating lots of debate but little action. And against the current backdrop of debt ceiling negotiations, its future is uncertain. [Read More]
  July 20, 2011

Editor's Picks
CO-OPs a Health Plan Alternative
The Department of Health and Human Services has announced proposed rules governing the creation of consumer-operated and -oriented health plans, or CO-OPs. They aim to be another consumer option for cost-effective healthcare insurance. [Read More]
Autism Treatment Denials Spark Lawsuits
Efforts to gain health insurance coverage for an autism treatment called applied behavior analysis have taken several steps forward in Michigan and California. Health plans traditionally balk at authorizing the expensive treatment on the basis that it is experimental or more of an educational service than medical care. Blue Cross and Blue Shield of Michigan is facing a class action suit for denying the treatment, while Blue Shield of California has reached a settlement to provide coverage for ABA services under certain circumstances. [Read More]

6 Target Markets for Accountable Care Partnerships
Criticisms of accountable care hinge on a false premise—that the only way to become accountable for care is to contract for shared savings with the Centers for Medicare & Medicaid Services. The reality is that there are many markets for providers to evaluate as they begin the journey toward more coordinated, accountable care, and a variety of partnerships and strategies that can be deployed to get there. [Read More]

Rounds: The Real Value of ACOs
Date: August 16, 2011
What: Attend on-site or participate via live webcast.
About: Get accountable care strategies from ACO pioneers Norton Healthcare, Humana, and Palmetto Health--first movers who already have experienced the challenges of building a new framework for healthcare delivery.
[Read More]
Webcast: Creating an ACO Marketing Language
Date: July 27, 2011
About: As a marketer, you need to learn the new paradigm of managing population health vs. growing patient volume in a traditional environment. Advance your understanding of how to align ACO marketing with business needs, as well as market accountability to providers, and ultimately your community.
[Read More]

Health Plan Forum
ACO or Not, Fairview Builds Shared Savings into All Payer Contracts
Minneapolis-based Fairview Health Services has taken a model for shared savings and quality improvements and gradually embedded the concepts into all of its commercial insurance contracts. [Read More]

Managed Care Headlines
Stakeholders React to Proposed HIX Rules
Margaret Dick Tocknell, for HealthLeaders Media, July 14, 2011

Hospital System, Citing Costs, Hones In On Employees' Health
Cheryl Clark, for HealthLeaders Media, July 18, 2011

WA Oncologist Indicted in $1.7M Medicare Fraud Scheme
John Commins, for HealthLeaders Media, July 15, 2011

Senators Batter CMS Over Anti-Fraud Efforts
Cheryl Clark, for HealthLeaders Media, July 14, 2011

Shuttered RHIO CareSpark?s chairman not giving up
Government Health IT, July 20, 2011

Health spending may be leveling off
National Journal, July 18, 2011

Medicare doesn?t cover many expenses for low-income seniors
The Washington Post, July 19, 2011

MI Blue Cross holding small group rate increase to 7.4%
The Detroit News, July 13, 2011


July 27: Webcast: Creating an ACO Marketing Language

August 16: Rounds: The Real Value of ACOs


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ACO Appeal for Hospitals Needs a Boost

Stephen L. Mansfield, PhD., president and CEO of Methodist Health System in Dallas discusses what needs to happen to get hospitals excited about ACOs and what it will take to make ACOs sustainable. [Sponsored by Emdeon] [Listen Now]
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