More than half of all state Medicaid programs incorporate a financial incentive encouraging providers to deliver better quality care, according to a study by the Commonwealth Fund. In addition, the study finds that 70% of existing Medicaid P4P programs operate in managed care or primary care management environments. Nine Medicaid programs are joining with other payers, employers and providers in statewide or regional P4P efforts, which is an indicator that the Medicaid plans are keeping pace with HMOs—half of which are offering P4P programs of their own.
Worldwide, 388 million people will die from chronic diseases in the next 10 years. Chronic diseases account for about 75% of all healthcare costs. Clearly, disease management and prevention is sorely needed, but it's been a struggle to change the behaviors of large groups of people. A number of programs are finding success using non-traditional methods.
Last month, the LA Times reported that Blue Cross of California had agreed to change its position on policy cancellations, now making a distinction between those who make honest mistakes on application forms and those who fraudulently misrepresent themselves to obtain benefits. The Times predicted that the class-action settlement would "send shock waves" through the insurance industry.
Deciphering diversity: Empire leader Mark Wagar studies melting pot of member-engagement opportunities
Every morning, Mark Wagar, president of Empire Blue Cross Blue Shield, walks more than a mile through Manhattan to his office on 42nd Street. It's a city of great diversity and that fact that isn't lost on him, especially considering that one in four New Yorkers is an Empire member.
As more health plans turn to automated, speech-enabled calls to reach out to members with welcome programs, preventive health reminders, or with more sensitive information about a specific condition, they must use an appropriate approach. Done correctly, such phone programs can provide a cost-effective way to speak with members.
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.
DOUGLAS E. HENLEY, MD, BELIEVES that the U.S. healthcare system is so fragmented, so disjointed and so disorganized that he finds it hard to even refer to it as a system.
NATIONAL REPORTS—Corporate wellness programs are top-of-mind for the majority of large, and even many mid-size employers, according to industry experts.