HealthLeaders Media Health Plan Insider - October 5, 2011 | The Essential Work of Defining Essential Healthcare Benefits View as a Webpage | Subscribe for Free
The Essential Work of Defining Essential Healthcare Benefits
Margaret Dick Tocknell, Senior Editor

The independent Institute of Medicine will soon release its report on which medical services should be deemed essential benefits, as required by the ACA. This work is fundamental to the future state of healthcare in America. But the IOM has tackled a seemingly impossible task. [Read More]
  October 5, 2011

Editor's Picks
NCQA Pushes for Clarity in HIX Proposed Rules
With proposed rules governing each state's health insurance exchanges under review, the National Committee on Quality Assurance is urging the Centers for Medicare & Medicaid Services to make sure that employers and the public can understand what they are buying. [Read More]
Citing Medicaid Limits, ED Docs Sue WA State
Emergency physicians in the state of Washington have filed a lawsuit against a state plan to classify more than 700 diagnoses as non-emergent, and limit Medicaid reimbursements to no more than three non-emergent visits to the emergency department each year. [Read More]
HHS Introduces Coordinated Care Pilot for PCPs
The Department of Health and Human Services is recruiting private payers to participate in the Comprehensive Primary Care Initiative, a four-year Medicare shared savings pilot aimed at primary care physicians. [Read More]
*NEW* Industry Survey 2012
We know you have something to say. And we want to hear it. Take the 2012 Industry Survey now—in 10 minutes or less, share your insight and help define industry trends. [Read More]
Webcast: Raise Revenue, Cut Costs in Your Joint Replacement Service Line
Date: October 12, 2011
About: The world of joint replacement surgery is changing as fast as the rest of healthcare. With less-invasive techniques spreading, surgical volume, competition, and costs are on the rise, while compensation is falling. Surgeons and service line leaders from Hudson Valley Hospitaland VHA discuss successful strategies on navigating surgical efficiency and volume, alignment challenges, and competition.
[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
Supreme Court hears convoluted case involving CA Medicaid cutbacks
The New York Times, October 4, 2011

Top 5 unnecessary healthcare costs
The Wall Street Journal, October 5, 2011

Hospitals push age hike for Medicare
Boston Globe, September 30, 2011

Medicare tests alternative to fraud-fighting smart card
InformationWeek, September 30, 2011

NJ?s Bayonne Medical Center, Horizon reach deal but new concerns arise
The Record, October 5, 2011

Supreme Court to hear case on Medicaid rates
The Hill, October 3, 2011

Stuck in bed, at hospital?s expense
The New York Times, October 3, 2011

Medicaid stand-in rebuffed by feds
Fort Wayne Journal Gazette, October 3, 2011

NY's Medicaid benefits costliest in US
The Journal News/, October 3, 2011


Oct 12: Webcast: Raise Revenue, Cut Costs in Your Joint Replacement Service Line

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

Nov 11: Rounds: The Business and Clinical Path to Medical Home


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Wellness Plans from Health Plans Aim to Add Value Across Provider Networks

Kevin Riley, CEO of GuideWell, a subsidiary of Blue Cross Blue Shield of Florida, discusses the rising interest in wellness by health plans and what this means for employers and healthcare costs. [Sponsored by Emdeon] [Listen Now]
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