Managed Care Calendar
- AAPM 2010 Clinical Meeting
Poll
Feature
Reports Document Growth of HSAs
Increases in Enrollment and Assets Continue
Led by growth among large-group insurers, enrollment in high-deductible health plans (HDHPs) and associated health savings accounts (HSAs) exceeded 10 million this year. Separate research projects recently conducted by America’s Health Insurance Plans (AHIP) and the Employee Benefit Research Institute (EBRI) quantify expansion in both the number and value of HSAs. After several years of increases, the continued expansion of HDHP/HSA arrangements may depend on how new regulations issuing from national healthcare reforms influe
Bay State Rate Battle
Massachusetts the Site of Latest Clash over Premiums
Although 4 of the state’s largest health insurers posted first-quarter losses that they attributed mostly to Governor Deval Patrick’s efforts to slow premium growth rates for individuals and small businesses, the Massachusetts Division of Insurance is holding firm on its decision to deny insurers’ requests for premium increases. Insurers challenging the rejections assert that premium increases are a direct and necessary result of the rising cost of medical care and say the denials amount to arbitrary price contro
Counting Their Medical Losses
Insurers Contemplate New Spending Requirements
Health insurers are considering the financial impact of mandatory medical loss ratios (MLRs) requiring them to spend minimum percentages of the premiums they collect on providing healthcare to customers. Starting in 2011, insurers will have to comply with federally mandated MLRs or provide rebates to consumers based on the amount that spending falls below these minimums. While stakeholders in the insurance industry work with regulators to determine precisely how the MLRs will be calculated and applied, some are taking preemp
Reimbursement Runaround Redux
Lawmakers Continue to Struggle with Doc Fix
Temporarily delaying mandated reimbursement cuts for physicians providing Medicare services has become a routine and recurring event in the US Congress. Since 2002, lawmakers have repeatedly passed legislative stopgaps to forestall reductions in the Medicare Physician Fee Schedule (MPFS) mandated by Medicare’s Sustainable Growth Rate (SGR) formula, but some of the recently enacted pay patches have lasted little more than a month. While lawmakers procrastinate, frustrated doctors continue to advocate a permanent solution, ofte
Association between Hospital Cost of Care and Quality of Care and Readmission Rates
The Centers for Medicare & Medicaid Services (CMS) routinely reports on >30 quality-of-care measures at all hospitals in the United States. To encourage patients to seek low-cost providers, as of August 2008, the CMS reports were expanded to include data about cost of care for common conditions. Likewise, in the private sector, payers often focus on tiered payment networks that encourage patients to choose hospitals with low costs and high quality of care.
To date, it is unclear whether efforts to reduce hospital costs will have adverse effects on the level of the quality
Insurers Prepare for Market Reforms
Challenges Include Cost Concerns, Legal Disputes
Despite bipartisan opposition in Congress and failure to win support of a majority of the public during months of debate, federal lawmakers were able to enact a comprehensive reform bill that creates new ground rules for the health insurance industry. The market reforms will improve access for millions of Americans who previously could not afford or qualify for enrollment in a health plan, but employers and insurers are warning about the lack of cost controls and the expense of new insurance mandates. Compounding the challenges of
Insurers Prepare for Market Reforms
Challenges Include Cost Concerns, Legal Disputes
Despite bipartisan opposition in Congress and failure to win support of a majority of the public during months of debate, federal lawmakers were able to enact a comprehensive reform bill that creates new ground rules for the health insurance industry. The market reforms will improve access for millions of Americans who previously could not afford or qualify for enrollment in a health plan, but employers and insurers are warning about the lack of cost controls and the expense of new insurance mandates. Compounding the challenges of
Rate Hike Battle Escalates
Insurers Blame Rising Costs for Premium Increases
With the health reform battle grinding on, premium increases in California and other states have been held up by legislators as the latest evidence that insurers need to be reigned in. In an attempt to build support for their reform efforts, lawmakers seized on an announcement by Anthem Blue Cross, a California subsidiary of WellPoint, that its individual market premiums would increase by as much as 39% as evidence that new price controls are necessary. Insurers have defended the rate increases, arguing that they reflect
Anatomy of Healthcare Reform
More to Agenda than Comprehensive Bills
Comprehensive legislation has been the centerpiece of the healthcare debate, but substantial portions of the reform agenda were enacted months before President Obama began calling for a final vote. Implementation of healthcare legislation packaged in smaller bills, such as the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), or tied to larger measures like the American Recovery and Reinvestment Act of 2009 (ARRA), has expanded the federal government’s role in funding health insurance as well as in medic
Healthcare Spending Hit by Slow Economy
CMS Report Depicts Government’s Increasing Role
Spending on healthcare in the United States totaled $2.5 trillion in 2009, a 5.7% increase, and accounted for 17.3% of the nation’s gross domestic product (GDP). Although job losses contributed to a reduction in private insurance enrollment, insurers saw better growth in private health insurance premiums than during 2008. Growth in public-sector healthcare spending outpaced increases in private outlays, and the government’s share of the national healthcare bill is projected to exceed 50% by 2012, according to projections rele
REQUIP XL is an oral dopamine agonist medication for Parkinson’s disease and had demonstrated significant improvement in the symptoms of Parkinson’s disease.
The Role of Immune Function in the Changing Landscape of RRMS Therapies
Gastroesophageal reflux disease (GERD) is an important
managed care health concern because it is one of the most common gastrointestinal (GI) disorders in the United
States. GERD affects nearly 18.6 million Americans, according to a national healthcare database analysis.
Parkinson’s disease (PD) is a progressive
and disabling neurologic disorder. The disease is the most prevalent type of parkinsonism, a clinical syndrome caused by lesions in the basal ganglia, predominantly in the substantia nigra, which produces deficits in motor behavior.
