Health plan costs - managed care (BenefitsLink.com)Headlines re Health plan costs - managed care, gathered by BenefitsLink.comQuality Monitoring and Management in Commercial Health Plans (PDF)- (Found July 5, 2008 ) Excerpt: "This survey of 252 HMOs found that almost all measure their performance on multiple indicators of quality and most use these data in quality improvement activities." (The American Journal of Managed Care)http://www.ajmc.com/files/articlefiles/AJMC_08jun_Landon377to386.pdf Total Health Management Strategies and Success Factors (PDF)- (Found July 5, 2008 ) 4 pages. Excerpt: "This issue focuses on THM success factors for sponsors of multiemployer health plans and includes a case study. The value of THM is not merely theoretical. Plan sponsors that have implemented a THM strategy have already seen savings." (The Segal Group, Inc.)http://www.segalco.com/publications/newsletters/jan2008.pdf CMS Outlines Value-Based Healthcare Purchasing Program- (Found July 5, 2008 ) Excerpt: "CMS this week outlined its long-awaited value-based purchasing program (VBP) proposal that would reduce diagnostic-related group (DRG) payments for Medicare patients, but give hospitals a chance to earn the money back through stellar performance or dramatic improvement. . . . Karen Linscott, acting CEO of The Leapfrog Group, said in a statement. 'Now that CMS' plan for value-based purchasing has been made public, the public and private sector can leverage their combined...http://www.healthleadersmedia.com/view_content.cfm?content_id=201274 More Health Insurers Adopt Doctor Ranking Model- (Found July 5, 2008 ) Excerpt: "More health insurers have adopted New York Attorney General Andrew Cuomo's doctor ranking model, thereby agreeing to fully disclose to consumers, physicians and plan sponsors the cost and quality metrics they use to rank doctors." (Workforce Management)http://www.workforce.com/section/00/article/25/23/62.html Seven Ways to Lower Benefit Costs Without Decreasing Coverage- (Found July 5, 2008 ) Excerpt: "Fear not, my HR brothers and sisters. Here are my Cliff notes for the top seven strategies to drop benefit costs without decreasing coverage. There's still time to get these in for 2008." (Workforce Management)http://www.workforce.com/section/02/feature/25/18/11/index.html UK Fat Patients Claim Discrimination- (Found July 5, 2008 ) Excerpt: "In Britain, some doctors appear to be setting a body mass index of 30 -- considered obese in Britain and the United States -- as an informal cutoff point for elective surgery. In the U.S. there are no absolute limits, but American doctors seem to be more lenient. One U.S. orthopedic surgeon suggested that not until a patient has a body mass index of 40 -- a category considered 'morbidly obese' -- would surgeons have serious problems." (AP via Yahoo! News)http://news.yahoo.com/s/ap/20071116/ap_on_he_me/britain_fat_patients;_ylt=AgmV4x Health Care Vendor Summits Promote Integration of Services (PDF)- (Found July 5, 2008 ) 6 pages. Excerpt: "Plan sponsors that must deal with a plethora of health care management and wellness vendors are pushing for greater coordination and integration among vendors. This trend stems from the fact that employee populations today have a variety of health and wellness issues that require different levels of interventions, such as case management to direct the delivery of care, and disease management for those who have chronic illnesses, as well as health coaching, wellness and...http://www.ifebp.org/pdf/webexclusive/07dec.pdf Managed Care Contract Gives Rise to 'Independent Legal Duty' Which Survives ERISA Preemption- (Found July 5, 2008 ) Excerpt: "The United States District Court in Northeast Hosp. Authority v. Aetna Health Inc. ultimately added another decision to growing list of cases in which managed care contracts permit payment disputes between provider and health plan to survive ERISA preeemption. The contours of a successful argument for provider reimbursement are taken from the outline of critical factors set forth in AETNA Health, Inc. V. Davila 542 U.S. 200 (2004)." (Health Plan Law blog by Attorney Roy F....http://healthplanlaw.com/?p=484 Self-Insured Employers Must Hold Service Providers' Feet to the Fire- (Found July 5, 2008 ) Excerpt: "When employers self-insure, they usually look to hundreds of available external administrative firms to manage claims and managed-care services. However, there is little oversight on these companies from public regulators or private compliance specialists. Thus, the most effective tool for vendor management is a two-fold approach that requires performance guarantees up front and ongoing oversight through periodic claim audits to evaluate and confirm reported accuracy...http://ebn.benefitnews.com/asset/article/302251/staying-current/self-insured-employers-mus... Study Shows Active Company Health Plan Managers Enjoy Lower Cost Increase- (Found July 5, 2008 ) Excerpt: "A press release about Towers Perrin's annual Health Care Cost Survey says 'high-performing companies' will see annual per-employee costs of about $1,500 less than low performers in 2008. While nearly a quarter of the survey respondents continue to struggle with double-digit cost increases, nearly half of the high performers are managing to get their increases much closer to the medical CPI of about 4%. Among high performers, 45% have cost increases of 5% or less."...http://www.plansponsor.com/pi_type11/?RECORD_ID=38874 |