The long-sought national interoperable health information system remains far from reality as standards prove difficult to establish, provider uptake goes slowly and privacy concerns continue. A year ago, there were high expectations that Congress would adopt legislation supporting the creation of standards for electronic health records (EHRs). That bill faltered over disagreements about anti-kickback language and new billing codes.
Typically not a big fan of movies, I was surprised by how much I enjoyed my DVD rental of "Man of the Year." The basic premise of the movie has a quirky, independent-party candidate winning the popular vote in a presidential race.
Experts say that 5% of all claims are fraudulent or abusive. If the total spent on U.S. healthcare annually is approaching $2 trillion, that 5% would add up to nearly $100 billion a year in fraudulent or abusive claims. And the percentage may be higher, perhaps as high as 10% of claims.
A number of cost-evaluation studies have emerged showing consumer-directed health plan (CDHP) members use less care. Meanwhile, others suggest that members are less satisfied with these plans and that they tend to choose unwise ways of saving money, such as skipping preventive care.
The mother of a child suffering from asthma calls Medical Mutual of Ohio's Nurse Line desperately needing advice. The nurse listens to the mother's concern and is poised to tell her everything she needs to know, but instead, the mother is told that she is not covered for this particular service.
A number of cost-evaluation studies have emerged showing consumer-directed health plan (CDHP) members use less care. Meanwhile, others suggest that members are less satisfied with these plans and that they tend to choose unwise ways of saving money, such as skipping preventive care.
When it comes to Medicare plans, managed care executives must find a way to increase value, say industry watchers.
Medicaid has to evolve into a delivery model that takes into account the uniqueness of each individual-both their specific health status, and issues outside of the traditional healthcare system, such as transportation, living conditions and substance abuse problems, according to insight from Newt Gingrich, founder of the Center for Health Transformation (CHT) and Rishabh Mehrotra, president and CEO of SHPS, a provider of health advocacy and health benefits solutions.
Hartford, conn.-In what industry watchers are calling the biggest example of marketing insurance products through an affinity group, Aetna and UnitedHealth Group will administer and deliver health insurance to AARP members.
National reports-In Idaho, the rate of uninsured is nearly 18%. National research shows that as the cost of health insurance premiums increases, so does the number of small businesses who drop coverage for their employees. And, in general, small businesses are least likely to offer health insurance to their employees.
Washington, D.C.-After months of speculation, the Bush administration named a veteran Health and Human Services (HHS) official to lead the Centers for Medicare and Medicaid Services (CMS) for the next two years.
Some industry behemoths such as the UnitedHealth Group and the Blue Cross Blue Shield Assn. (BCBSA) have decided to keep the member financial services in-house, creating their own banks. Other payers are developing relationships with multiple banks to offset the giants' economies of scale with flexibility and portability, allowing members to keep their money in the same bank even when they change health plans.
An assignment of benefits is a transfer of an insured's interest in policy benefits to another party. The policy generally requires a written assignment by the insured to the provider, allowing the provider to bill the health plan directly. Such an assignment results in the payment of medical benefits directly to the healthcare provider rather than to the insured.
Trumpeting the now-popular battle cry of transparency, many states are attempting to control the contractual arrangements between pharmacy benefit services providers and their clients. Because of the historical issues around hidden revenue streams and misaligned objectives, it is no wonder the public sector is taking note.
State regulation of pharmacy benefit managers (PBMs) would benefit states and consumers by providing a regulatory framework for the only entity involved in delivery of a healthcare benefit to the consumer that is largely unregulated.
Healthcare organizations are intimately familiar with intense prosecutorial scrutiny resulting from the government's battle against fraud and corruption. There are prominent examples of focused federal fraud investigations, resulting in hefty settlements. Congress has now enlisted the healthcare industry in their campaign against fraud.
There is growing recognition that teenagers have healthcare needs that are distinct to their own age group-needs that pediatricians and primary care physicians are not always equipped to handle.
ALTHOUGH THE NUMBER of North Americans and Europeans seeking care abroad is relatively small-about 150,000 Americans traveled abroad for care in 2005-it's expected to grow as more patients learn about the option and as overseas hospitals, healthcare travel firms and insurers lay the groundwork to accommodate them.
At present, most states have made HMOs subject to their insurance holding company acts. Insurance holding company acts are comprehensive bodies of law that govern the relationships and activities within insurance holding company structures. These laws indirectly regulate the activities of entities that are affiliated with insurance companies and HMOs, which would not otherwise be subject to regulation.
Despite a mounting clamor for reform from many health policy experts, Senate action to reduce payments to Medicare Advantage may be postponed this year. Influential senators oppose an across-the-board cut, which would reduce MA plan activity in rural and low-cost regions.
WASHINGTON, D.C.-Legislation permitting federal government negotiation of Medicare drug discounts has stalled in the Senate, partly due to disputes over the measure's potential for savings. A coalition led by Sen. Debbie Stabenow (D-Mich.) claimed that government negotiation of Medicare drug prices would save patients and taxpayers $30 billion a year. That number assumes such a change would yield 40% drug price reductions to match rates obtained by the Department of Veterans Affairs health program.
NATIONAL REPORTS-The proposed merger of Highmark Inc., of Pittsburgh, and Independence Blue Cross (IBC), of Philadelphia, combines two large health plans into a single organization that would become the dominant player in the Pennsylvania market. It also represents another step in the consolidation of the health plan marketplace, say industry experts.
Apparently somebody forgot to carry the one. The U.S. Census Bureau recently revised its 2005 data on the uninsured and now reports that the initial numbers were off by 1.8 million people. New totals show 44.8 million people were uninsured in 2005, not the 46.6 million previously reported.
Twenty years ago, health insurance was marketed on a wholesale basis. Over the past five years-as managed care turned mainstream-different product designs have surfaced and become more retail oriented.
As healthcare costs continue to spiral out of control, state officials across the country are pursuing creative ways to control the high costs of Medicaid services for low-income women, children, the disabled and the elderly.
