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| Tricky poverty measures influence coverage levels
| | | By
Julie Miller
| | | Millions of people's lives have been influenced by the work of Mollie Orshansky, even though very few people know who she is. Dozens of health-related programs throughout history have benefitted from Mollie's contributions, including programs through HHS, charitable agencies, private companies and managed care. In 1963, it was Mollie—an accomplished mathematical genius and daughter of a poor immigrant family—who developed the U.S. government's official measure of poverty and the guidelines for what we call the Federal Poverty Level (FPL) today.
| | | Corporate practice of medicine seen as ancient approach
| | | By
Barry Senterfitt
| | | The Illinois Supreme Court recently confirmed that the corporate practice of medicine doctrine is still alive and well in the state of Illinois. In Vine Street Clinic, et al. v. HealthLink Inc., the court concluded that percentage-based fees charged by the owner of a healthcare provider network were illegal under the state's medical practices act.
| | | Medicare Advantage plans under attack
| | | By
Jill Wechsler
| | | Rising pressure to reduce federal spending for Medicare has put the spotlight on payments and policies governing the Medicare Advantage program. MA plans are "vastly overpaid," according to Rep. Pete Stark (D-Calif.), chairman of the House Ways & Means Health subcommittee, largely because they sign up more healthy beneficiaries. Senate Finance Committee chairman Max Baucus (D-Mont.) is looking closely at whether "funneling dollars into private plans gets us the most bang for our healthcare buck."
| | | Integrated, flexible incentive programs encourage change
| | | By
Sue Lewis, M.Ed
| | | Consumerism in health benefits has moved beyond buzzword status to a mainstream strategy. Increasingly, health plans and employers view consumerism with a global approach to benefits—a collaboration with employees financially, organizationally and personally.
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| Automakers look at trust funds to manage retiree benefits
| | | By
Tracey Walker
| | | Detroit's Big Three automakers are considering shifting future retiree healthcare costs to union-controlled trust funds and are eyeing a new contract between Goodyear Tire & Rubber Co. and the United Steelworkers (USW) union.
| | | Mental health parity bill provides flexibility for insurers
| | | By
Jill Wechsler
| | | Legislation encouraging more equitable coverage of mental illness is moving forward in Congress following important modification of previous requirements. The Senate Health, Education, Labor and Pensions (HELP) Committee recently approved a bill that requires health plans to offer similar benefits for mental and physical illness in terms of deductibles, copayments and treatment limitations. But the new measure no longer mandates that group health plans cover mental illness.
| | | Bush plan seeks huge Medicare savings
| | | By
Jill Wechsler
| | | The Bush administration spending plan for 2008 proposes major funding curbs for Medicare, Medicaid, children's health and other government health programs.
| | | Unusual organization partnerships aim to reform healthcare
| | | By
Tracey Walker
| | | Wal-Mart and the Service Employees International Union (SEIU) have formed what industry watchers have called an "unusual" partnership to push for quality, affordable healthcare.
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| Coverage for specific drug classes
| | | By
Tracey Walker
| | | Over the next few years, more health plans and employers will investigate covering the physician-administered injectable drugs under the pharmacy benefit as a way to control the costs and manage appropriate utilization, says Kathryn Lindhorst Canaday, PharmD, director of pharmacy analysis, Pharmaceutical Strategies Group (PSG), based in Dallas.
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| Case management for seniors requires heightened coordination
| | | By
Mari Edlin
| | | The centers for Medicare and Medicaid (CMS) says that 23% of Medicare beneficiaries have five or more chronic conditions but account for 68% of costs—not quite the 80/20 rule. And they tend to see many different doctors—about 14 a year with almost 40 office visits—and take as many as 10 medications at a time, according to Partnership for Solutions.
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| Plans choose coverage for HPV vaccine, ponder routine mandate
| | | By
Mari Edlin
| | | As health plans elect to cover a new FDA-approved vaccine that protects girls and women against strains of the human papillomavirus (HPV), parents might wonder if it will be mandated by states as a routine immunization for girls at a certain age.
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| Effective prophylactic drugs reduce surgery infections
| | | By
Elaine Zablocki
| | | Surgical site infections are a significant problem in hospitals today. They occur in 2% to 5% of patients who have clean operations outside the abdomen, and in up to 20% of patients with intra-abdominal procedures. They account for about 15% of hospital-acquired infections.
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| Hospitals look to improve infection-prevention measures
| | | By
Ken Krizner
| | | The primary cost to patients with hospital-acquired infections is a prolonged stay and additional therapeutic interventions. But because of the high financial costs, there is increasing outside pressure to decrease infection rates.
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