HealthLeaders Media Health Plan Insider - September 7, 2011 | 5 Challenges for CO-OPs View as a Webpage | Subscribe for Free
5 Challenges for CO-OPs
Margaret Dick Tocknell, Senior Editor

Accountable care organizations, integrated delivery systems, and chambers of commerce are likely candidates to form consumer-operated and -oriented health insurance plans. But one analyst wonders if $3.8 billion in government loans will be enough to guarantee the success of this latest option to individual and small business healthcare coverage. [Read More]
  September 7, 2011

Editor's Picks
Insurers Eye Medicare Advantage Acquisitions
In the past 12 months three health insurers, HealthSpring, WellPoint, and Humana, have each acquired a Medicare Advantage HMO. Expect to see even more growth as businesses begin to shift their 65 year-old and older retirees off of employee -sponsored plans and onto Medicare Advantage plans. [Read More]
Strategic Options: It's Not ACO or Nothing
An organization that rushes to implement an accountable care model and operational plans that address various forms of clinical integration runs substantial risks if it moves ahead without a clear framework for its future direction, says a strategist. [Read More]
CA Medical Biller to Pay $4.6M to Settle Fraud Allegations
Janzen, Johnston & Rockwell Emergency Medicine Management Services has agreed to pay the federal government to settle fraud allegations stemming from overcharges at the company's Medicare and Medicaid operations, the Department of Justice says. [Read More]
Breakthroughs: The High-Performing Surgical Program
Given a reimbursement model based on outcomes, not volume, only those surgical services that can deliver state-of the-art care, value, and an outstanding patient experience will survive. In this HealthLeaders Media Breakthroughs report, leading hospital systems—St. Francis Hospital, Methodist Hospital System, The Mount Sinai Medical Center, and Bassett Healthcare—share lessons learned about new ways of approaching surgical care and strategy. [Read More]
Rounds: Performance Improvement for Quality and Bottom-Line Outcomes
Date: October 26, 2011
About: Attend on-site or participate via live simulcast. Host Denver Health with invited guest Virtua share how to make continuous quality improvement with a focus on bottom-line value part of your institutional culture and process.
[Register Today]

Health Plan Forum
Norton, Humana Commercial ACO Notches Cost Savings
In a pilot, the partners have begun to track improvement along several initiatives, including a joint replacement accountability study that has seen a 7.3% reduction in direct variable cost, a 6.7% reduction in length of stay, and a 13% reduction in 30-day readmissions. [Read More]

Managed Care Headlines
Parkland expects CMS report by Sept. 15
Dallas Business Journal, September 7, 2011

MA legislator seeks cuts to highest health payments
The Boston Globe, September 6 2011

Medicaid transparency push riles state officials
The Hill, September 6, 2011

Healthcare Creates 1 in 5 New Jobs
John Commins, for HealthLeaders Media, September 2, 2011

Bill to regulate CA health insurance rates is shelved
Los Angeles Times, September 2, 2011

Health insurers must justify rate increases under new rules
The Plain Dealer/McClatchy-Tribune News Service, September 2, 2011

Drug makers take new tack against generics
The Boston Globe, September 2, 2011

UnitedHealth to buy CA doc group
BusinessWeek, September 2, 2011

Antibiotic prescriptions for kids fall, but the news isn?t all good
The Wall Street Journal, September 2, 2011


Sept 15: Rounds: Women's Health Strategies for Service Line Growth and Quality

Sept 16: Webcast: Slash Your Readmission Rates

Sept 22: Webcast: Quantify & Cultivate Patient Engagement

Oct 26: Rounds: Performance Improvement for Quality and Bottom-Line Outcomes


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From HealthLeaders Magazine
Nurse Education Key to Scope-of-Care Debate

There is tension between nursing leadership and some physician groups over the scope of what advanced practice nurses, including nurse practitioners, should be allowed to do. [Read More]

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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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