Physicians Object to Blue Cross Letter

Friday, February 15,2008
Physicians balk at Blue Cross CA request to physicians to report on patient applications that do not disclose all pre-exisiting conditions. See Link for full story.
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Capitation Revival?

45% of Doctors accepted capitated payments in 2004-2005
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February 27-29, 2008

The Beverly Hilton

Los Angeles, CA



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AMGA 2008 Annual Conference

March 6-8, 2008

J.W. Marriott Grande Lakes

Orlando, FL



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Physicians Learn of Mistakes from Colleagues, Not Systems

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IOM Issues Report on Need for Comparative Effectiveness

The Institute of Medicine (IOM) last week issued a 280-page report entitled "Knowing What Works in Health Care: A Roadmap for the Nation," that recommends the creation of a national program to assess the effectiveness of clinical services. The report highlights problems inherent in the current health care delivery system and makes suggestions for building a foundation for knowing what works in health care through systematic reviews of clinical effectiveness and the development of a common language and standards for conducting the reviews. To see the report brief or to order a copy of the full text of the report, go to the IOM Website.

More Families Face Lifetime Benefit Cap

A growing number of American families are hitting the lifetime benefit cap of $1 Million or more that's standard to most insurance policies, prompting advocates to lobby Congress to require the cap be lifted to $10 million. The cap is typically seen in those who need organ transplants or have hemophilia and other chronic illnesses that can rack up medical bills. Facing healthcare bills of hundreds of thousands of dollars, families have started seeking help from the federal government, changing jobs or even divorcing just to land new health insurance. Exact figures on how many Americans exceed the lifetime caps weren't known, but advocates say the amount of the cap hasn't changed in decades.

Quoted from: HealthLeaders-Interstudy Health Plan Weekly Update

Wal-Mart Pledges To Lower Healthcare Costs

Giant retailer Wal-Mart is using its purchasing power to lower healthcare costs by tackling everything from prescription costs to electronic health records. Wal-Mart President and CEO Lee Scott announced the plans at the company's annual kick-off for U.S. stores. Scott said the company would take out unnecessary costs while providing quality healthcare products and services. On the drug side, Wal-Mart will partner with physicians and other providers to increase the number of electronic prescriptions. It also will offer electronic health records to U.S. associates and family members by the end of 2010. Last April officials said they would invest in healthcare IT, and use the company's expertise in the retail marketplace to help lower healthcare costs for its employees - and the nation. The company pleged $1 million over five years to fund a new Center for Innovation in Health Care Logistics at the University of Arkansas.

Quoted from: HealthLeaders-Interstudy Health Plan Weekly Update

HSA Deposits Reach Half Billion Mark

HSA Bank, a division of Waterbury, Conn. - based Webster Bank, says it is the first health savings account administrator in the country to surpass $500 million in HSA deposits. HSA Bank has consistently ranked with the highest deposits since independent monitors have begun keeping track of such things in 2005. It serves members in every state, and has 10 years' experience in managing medical savings instruments.

Quoted from: HealthLeader-Interstudy Health Plan Weekly Update

Medicaid Helps UnitedHealth Earnings

UnitedHealth Group posted a 3 percent increase in net income, meeting analysts' expectations and assisted by gains in its Medicaid plan unit. Earnings rose to $1.22 billion, or 92 cents per share, while revenue eked up 3 percent to $18.7 billion. The gains in Medicaid, where revenue rose 24 percent to $1.2 billion, were tempered by higher spending for Medicare plans and seasonably high use of medical services in its commercial plans. UnitedHealth's medical loss ratio - the percentage of revenue that it actually spends on providing care - improved by 10 basis points to 79.9 percent.

Quoted from: HealthLeaders-Interstudy Health Plan Weekly Update

Bredesen Warns Against 'Stupid' Plans to Spend Reserves

Gov. Phil Bredesen is warning against raiding Tennessee's reserves despite indications that the state budget could be facing a shortfall of more than $200 million this year. Bredesen is scheduled to give his annual state of the state address Monday night, Jan. 28, during which he is expected to include his plans for bridging the funding shortfall. Although the state has accumulated about $600 million in TennCare (the state's Medicaid program) reserves and is projected to have another $750 million accumulated in its rainy day fund by the time the current budget year begins on July 1, Bredesen told The Associated Press that he's disturbed by suggestions by some lawmakers that the reserves could be tapped to plug budget gaps. "The notion that I'm beginning to hear is that the TennCare reserves are generous, so let's pull them down so we don't have to make some tough budget choices next year, " Bredesen said. "But plugging gaps in the ongoing budget by drawing down reserves is just stupid."

Quoted from: HealthLeaders-Interstudy Health Plan Weekly Update

Healthspring Ups Profit Outlook

Nashville-based HealthSpring Inc., a managed care company, expects profits between $1.50 and $1.52 per share, an increase from a prior forecast of $1.40 to $1.45 per share. The new projections include a final adjustment payment from Medicare, which equals about 13 cents per share. The company expects enrollment in its Medicare Advantage insurance plan will grow to between 158,000 and 163,000 members, from about 153,000, where it was at the end of 2007. Prescription drug plan membership is expected to grow to 260,000, up from 139,00 at the end of 2007, according to the company.

Quoted from: HealthLeaders-Interstudy Health Plan Weekly Update

Insurers Target Federal Funds

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Senators Write CMS Head Supporting AMGA Goals

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Reimbursement Rate Cut May Be Delayed By 18 Months

Congressional Democratic Finance Committee leaders have decided, at least for the moment, to write Medicare legislation this spring containing an 18-month delay in the 10.6 percent physician reimbursement rate cut scheduled to take effect on July 1. Members of Congress have expressed concern that physicians may stop seeing Medicare patients if their reimbursements decline.

But the cost, according to the Democratic leaders, would be between $12 billion and $15 billion over five years. With sweeping cuts in Medicare Advantage (MA) likely off the table, the Democrats will examine more targeted reductions, including bonus payments to hospitals with teaching programs and private fee-for-service plans. Medicare payments to providers of oxygen services in patients' homes may also come in for change.

White House Wants Mandatory EMR in Medicare Reimbursement

The chasm between Democrats and Republicans on health care reform this year is wide and deep. But both sides agree that Congress must pass legislation eliminating a proposed reduction in Medicare reimbursement effective July 1.

The White House, however, would like a mandate in any reimbursement legislation requiring physicians to adopt electronic medical record-keeping (EMR) or face fewer dollars from Medicare.

Health and Human Services Secretary Mike Leavitt said EMR helps physicians coordinate care and has the potential to reduce health care costs. Furthermore, he said, the mandate reflects the administration's commitment of providing beneficiaries with more information about the price and quality of their care.

Democrats support EMR, but are cool to the idea of predicating physician reimbursement on the purchase of technology. According to Rep. Frank Pallone (D-NJ), chair of the Energy and Commerce health subcommittee, "It has become an excuse to reduce their rates."

Cancelled: Clinical Operations Committee Meeting

The meeting scheduled for February 7, 2008 has been cancelled due to a schedule conflict.