HealthLeaders Media Health Plan Insider - July 27, 2011 | Understanding MLR Waiver Requests View as a Webpage | Subscribe for Free
Understanding MLR Waiver Requests
Margaret Dick Tocknell, Senior Editor

For the most part, the basis for requesting -- and being granted -- an MLR waiver falls into a single category: fear that meeting the federal standard will destabilize the individual insurance market and result in fewer choices for consumers. [Read More]
  July 27, 2011

Editor's Picks
CMS to Perform Rate Reviews in 10 States
Ten states have been notified that the Center for Medicaid & Medicare Services will be taking over responsibility for reviewing certain health insurance premiums increases proposed by insurers in their states. [Read More]
AAFP Calls For Revisions to RVU Formula
The relative value unit formula, which determines physicians' pay, is based on work, practice expenses, and malpractice costs. Now the American Academy of Family Physicians wants 'cognitive value' to be a consideration. [Read More]

CHF Readmission Prevention Efforts Prove Costly for Hospital
A transitional care intervention program for congestive heart failure patients at a Texas hospital reduced readmissions by 48%, but because Medicare did not pay the average $1,100 cost per patient, the facility lost money. [Read More]

Hospital files $9.2 million claim for treatment
Tampa General Hospital has filed a $9.2 million claim against the estate of a woman who died after spending five years in the hospital, according to court documents. "That would have to be the biggest bill I've heard of," said Alan Levine, a division president at the Naples-based hospital chain, Health Management Associates. [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]
Intelligence Report: Better Care and the Bottom Line
54% of leaders say that ACOs will be successful in coordinating care and driving down overall costs, according to this HealthLeaders Media Intelligence Report. Get the free report with exclusive research and analysis. [Read More]

Health Plan Forum
Understanding Bundled Payments
A bundled payment can be thought of as a budget. For a given episode of care, a group of "at-risk" providers agrees to work together to ensure that care is coordinated and that the total cost of an episode is within the budget. Under this model, the costs of any unplanned readmissions or complications are the responsibility of the providers, creating an economic incentive to prevent those costly events. [Read More]

Managed Care Headlines
CMS IDs Improper Payments, Top Regional RAC Issues
James Carroll, for HealthLeaders Media, July 27, 2011

Hospitals 'lien' on patients for medical bills, July 27, 2011

LA Gov. Jindal announces firms for Medicaid privatization / The Times-Picayune, July 26, 2011

Ex-employees say Prime hospitals stretch to keep patients
California Watch, July 25, 2011

Kaiser Genotypes 100,000 Members
Margaret Dick Tocknell, for HealthLeaders Media, July 25, 2011

Low Health Literacy Links to Healthcare Spending Confirmed
Cheryl Clark, for HealthLeaders Media, July 25, 2011

Healthcare Cost Growth Up Slightly
John Commins, for HealthLeaders Media, July 22, 2011

Health plan a huge problem for Jackson Health System
Miami Herald, July 22, 2011


August 16: Rounds: The Real Value of ACOs


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Audio Feature
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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