MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'care organizations'. Sat, 03 Sep 2011 02:58:10 +0100 http://www.medworm.com/index.php?rid=5125824&cid=t_454997_113_f&fid=34625&url=http%3A%2F%2Ftraffic.libsyn.com%2Fnversel%2FVi_Shaffer_AMDIS_2011.mp3 Back in June, I covered the Wisconsin Technology Network’s Digital Healthcare Conference in Madison. That conference featured a panel with Vi Shaffer, research vice president and industry services director for healthcare providers at Gartner, Judy Murphy, vice president of information services at Aurora Health Care in Milwaukee, and Epic Systems CEO Judy Faulkner, based in nearby Verona, Wis. The panel discussed the question, “Is meaningful use a floor or a ceiling?” as I reported for WTN News. The conference also featured several sessions on how business intelligence and health information exchange can support Accountable Care Organizations. A month later, I saw Shaffer again at AMDIS Physician-Computer Connection meeting in Ojai, Calif. There, she presented preliminary ... Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=5125824 Fri, 12 Aug 2011 17:24:05 +0100 5125824 http://www.medworm.com/index.php?rid=5107648&cid=t_454997_113_f&fid=34634&url=http%3A%2F%2Fwww.emrandhipaa.com%2Fneil%2F2011%2F08%2F04%2Frandom-thoughts-emr-projects-decentralized-problems-persist-despite-solutions%2F Once in a while, I run out of Big Ideas to share and resort to a rundown of short items. This is one of those times. Often, though, that approach turns out to be more interesting than a well-thought-out commentary. (Thus, the popularity of Twitter, right?) Speaking of Big Ideas, I’m thinking that the age of the massive EMR project may be coming to an end. You may have seen my piece in InformationWeek today about the reported end of the national EMR in England. London’s The Independent reported earlier this week that the Cameron government will announce next month that it will scrap the national strategy in favor of allowing local hospitals and trusts to make independent EMR purchasing and implementation decisions. This news comes on the heels of a decision by the government of ... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=5107648 Thu, 04 Aug 2011 22:22:35 +0100 5107648 http://www.medworm.com/index.php?rid=4934435&cid=t_454997_113_f&fid=34625&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FNeilVerselsHealthcareItBlog%2F%7E3%2FcaoEF1XUOg0%2F That’s the subject of my weekly post on EMR and HIPAA, based on two stories I’ve written in the last 24 hours and a conference I attended last week in Madison, Wis. Check it out.   Related posts:CDS commentary on EMR and HIPAA blog A business opportunity and a milestone Deborah Peel on Fox Business (Source: Neil Versel's Healthcare IT Blog) Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=4934435 Thu, 16 Jun 2011 21:05:28 +0100 4934435 http://www.medworm.com/index.php?rid=4820955&cid=t_454997_113_f&fid=35744&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fe-CareManagement%2F%7E3%2F5iLWq8bfPRM%2F It’s time to call it — the Medicare Shared Savings (SS) ACO is dead-in-the-water. Ironically — at the same time — commercial payers are awakening to ACO opportunities. Please read further. (more…) Article Series - Accountable Care Organizations: Cure-du-Jour or Real Collaborative Care?The Big Idea in Understanding “Accountable Care Organizations”The Achilles Heel of ACOs? Shared Savings Payment Model Unlikely to Motivate HospitalsA Dark Horse in ACO Formation: Large Physician Groups“Does This ACO Thing Really Mean We Need to be ‘Accountable’”Will ACO IT Models Be Walled Gardens or Open Platforms?10 Reasons Why an Open IT Platform Strategy is the Right Long-Term Choice for an ACOIs Economic Credentialing A Tool for Primary Care to Lead... e-CareManagement blogs http://www.medworm.com/rss/comments.php?id=4820955 Fri, 13 May 2011 23:12:43 +0100 4820955 http://www.medworm.com/index.php?rid=4820950&cid=t_454997_113_f&fid=34625&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FNeilVerselsHealthcareItBlog%2F%7E3%2F-gmzgCD_78g%2F I’ve just finished my latest post for EMR and HIPAA, based on a session I moderated this week at the the Institute for Health Technology Transformation health IT summit in Fort Lauderdale, Fla. Here’s a taste: The panelists did great job of articulating some of these conundrums and strategies to overcome them, but none better than Kevin Maher, director of clinical innovations for Horizon Healthcare Innovations, a new affiliate of Horizon Blue Cross Blue Shield of New Jersey tasked with testing new care models, and Victor Freeman, M.D., quality director in the Health Resources and Services Administration‘s Office of Health IT and Quality. The patient-centered medical home is a great idea for managing care, promoting prevention and, ultimately reducing costs. “We view the ba... Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=4820950 Thu, 12 May 2011 21:59:53 +0100 4820950 http://www.medworm.com/index.php?rid=4813404&cid=t_454997_113_f&fid=34625&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FNeilVerselsHealthcareItBlog%2F%7E3%2FWNwZU_GkVps%2F Oh man, I’ve been busy. I filled in as writer of the Midwest edition of Payers and Providers the last two weeks because regular editor Duncan Moore, a former colleague, had been hospitalized. (Get well soon, Duncan.) I’ve been at the Institute for Health Technology Transformation health IT summit in Fort Lauderdale, Fla., since yesterday, and I’ve also had my regular deadlines for InformationWeek and MobiHealthNews. I moderated two IHT2 conference sessions yesterday, on how health IT underpins Accountable Care Organizations and how business intelligence can create a framework for health information exchange. I haven’t had time to blog about those, but several people seem to have tweeted during those sessions. I therefore present a rundown via Twitter. @narmi91 #iHT2... Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=4813404 Thu, 12 May 2011 00:13:28 +0100 4813404 http://www.medworm.com/index.php?rid=4813286&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-accountable-care-organizations-acos-will-fail-to-reduce-costs%2F2011.05.11 In an ideal world ACOs should work. There is no evidence that  untested and complex organizational structure of ACOs developed by Dr. Don Berwick (head of CMS) will improve quality of care and reduce costs. ACOs are supposed to provide financial incentives to health care organizations to reduce costs and improve quality. There are too many defects in the ACOs infrastructure to improve the financial and medical outcomes. At a conceptual level, the incentive for ACOs would be to increase efficiency and avoid overuse and duplication of services, resources, and facilities. In this model, ACO members would share the savings resulting from the increased coordination of care. I have said over and over again that excessive administrative fees and ineffective management of chronic disease is the m... Better Health blogs http://www.medworm.com/rss/comments.php?id=4813286 Wed, 11 May 2011 18:00:41 +0100 4813286 http://www.medworm.com/index.php?rid=4780312&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Faccountable-care-organizations-acos-hmos-with-lipstick%2F2011.05.03 Thousands of articles have been written about forming ACOs. Millions of dollars have been spent by hospital systems to try to form an ACO. Healthcare policy consultants have discovered a new cash cow. Hospitals systems are wasting their money. They think the return from owning salaried physicians’ intellectual property will be more than worth the cost. Thousands of physicians have been confused by the concept of ACO. Many have felt ACOs are an attack on their freedom to practice medicine the best they can. Many have rejected the concept because they feel they will have to be salaried by hospital systems. Many physicians do not trust President Obama or Dr. Don Berwick. The Stage 2 ACO regulations are not easy to understand. They are more ominous than the stage 1 regulations. The two cor... Better Health blogs http://www.medworm.com/rss/comments.php?id=4780312 Tue, 03 May 2011 14:00:50 +0100 4780312 http://www.medworm.com/index.php?rid=4771024&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-medical-condition-is-the-most-costly-to-employers%2F2011.04.30 Ok…here’s a brain teaser.  What medical condition is the most costly to employers?  I’ll give you a hint.  It is also a medical condition that is likely to go unrecognized and undiagnosed by primary care physicians. If you guessed depression you are correct. If you mentioned obesity you get a gold star since that comes in right behind depression for both criteria…at least in terms of cost and the undiagnosed part. Four out of every ten people at work or sitting in the doctor’s waiting room suffer from moderate to severe depression.  Prevalence rates for depression are highest among women and older patients with chronic conditions.  Yet despite its high prevalence and costly nature, depression is significantly under-diagnosed (<50%) and under-treated by physicians. For em... Better Health blogs http://www.medworm.com/rss/comments.php?id=4771024 Sat, 30 Apr 2011 19:00:08 +0100 4771024 http://www.medworm.com/index.php?rid=4734099&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-accountable-care-organizations-acos-will-not-solve-our-healthcare-cost-crisis%2F2011.04.20 In 2009 President Obama stated that Accountable Care Organizations (ACOs) were going to be pilot programs in real world settings. The goal was to see if they effective in reducing costs and increasing “quality of care.” The results of the pilot programs have not been published. Last week despite the lack of proof of concept HHS and CMS announced new proposed regulations for ACOs. The new delivery and payment model the agency estimates could serve up to 5 million Medicare beneficiaries through participating providers, and also potentially save the Medicare program as much as $960 million over three years. How were these estimates derived? It could be another accounting  trick by President Obama’s administration. The idea of coordinating care and developing systems of care is a great... Better Health blogs http://www.medworm.com/rss/comments.php?id=4734099 Thu, 21 Apr 2011 01:00:07 +0100 4734099 http://www.medworm.com/index.php?rid=4709203&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysicians-wary-of-healthcare-reform-models-intended-to-save-primary-care%2F2011.04.13 When I talk to internal medicine audiences around the country about the latest health policy flavor of the day – accountable care organizations (ACOs) – a typical reaction is skepticism trending toward cynicism. Many don’t quite get what ACOs are all about and certainly don’t want to be lectured about how they need to re-invent their practices. And they don’t buy the idea that ACOs will somehow save internal medicine primary care. The same can be said, perhaps to a lesser extent, about their reactions to PCMHs (Patient-Centered Medical Homes), P4P ( pay-for-performance), HIT (health information technology), MU (meaningful use), and the whole alphabet soup of other reforms being proposed to reform health care delivery and payment systems. And who can blame them? Older inte... Better Health blogs http://www.medworm.com/rss/comments.php?id=4709203 Wed, 13 Apr 2011 23:00:00 +0100 4709203 http://www.medworm.com/index.php?rid=4696617&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fin-brief-new-accountable-care-organization-aco-regulations%2F2011.04.11 ACO regulations and related federal issuances hit the street last Thursday, after several months of waiting — from CMS, OIG, FTC, DOJ and IRS.  They cover the waterfront, ranging from the central regulation defining the structure and workings of the ACO, to  limited Stark self-referral ban and anti-kickback statute waivers in the fraud and abuse arena, to new frameworks for antitrust analysis, to rules governing joint ventures involving taxable and tax-exempt organizations. I had the opportunity to discuss the regs the day after they were issued on a special edition of the Blog Talk Radio show, ACO Watch, hosted by Gregg Masters (@2healthguru).  Gregg’s guests included Mark Browne (@consultdoc), Vince Kuraitis (@VinceKuraitis), Jaan Sidorov (@DisMgtCareBlog) and yours truly ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4696617 Mon, 11 Apr 2011 12:00:09 +0100 4696617 http://www.medworm.com/index.php?rid=4696712&cid=t_454997_113_f&fid=34625&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FNeilVerselsHealthcareItBlog%2F%7E3%2FnZFN64nSeww%2F It’s been a full decade since the Institute of Medicine published the second volume in its landmark series on patient safety and quality of care, Crossing the Quality Chasm. We appear to be not much closer to achieving a high-quality health system as we were 10 years ago. Last week, as you may have already heard, a paper in Health Affairs from researchers at the University of Utah concluded that adverse events may be 10 times more prevalent than previously believed and that errors may occur in an astounding one-third of all hospital admissions. The research team, which included such luminaries as Dr. David Classen, Dr. Brent James and the Institute for Healthcare Improvement‘s Frank Federico, also said that there estimates probably were on the conservative side. Patient-safety ... Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=4696712 Sun, 10 Apr 2011 21:07:53 +0100 4696712 http://www.medworm.com/index.php?rid=4676902&cid=t_454997_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2FpPQ_bVNqlgg%2F Nothing like enjoying the end of the weekend by going over some tweets from interesting people in the healthcare IT and EMR world. The first one hit me the strongest since I think I sometimes get so wrapped up in the details of EMR and healthcare IT that I forget to stop and remember really why we’re doing all of this. Thanks Diane for reminding us. #bbpBox_54579505100107776 a { text-decoration:none; color:#0084B4 !important; } #bbpBox_54579505100107776 a:hover { text-decoration:underline; } What are the ends of medicine? To cure sometimes, relieve often, comfort always. Regardless of wealth or lack thereof. about 14 hours ago via ÜberSocial @DianeEMeier Diane E. Meier After John Chilmark from Chilmark Research skipped doing his taxes (thankfully mine a... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=4676902 Mon, 04 Apr 2011 06:22:19 +0100 4676902 http://www.medworm.com/index.php?rid=4670079&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F04%2Flogical-fallacies-in-support-of.html The kerfuffle over the huge golden parachute given the departing CEO of an ostensibly non-profit Massachusetts health insurer/ managed care organization continues to evolve (see posts here and here), providing some new insight into governance problems afflicting health care organizations.  One of the issues that aroused initially aroused concern was that Massachusetts Blue Cross Blue Shield paid the members of its board of trustees substantial amount, an unusual practice for a non-profit organization.  Board members who feel they owe their pay to the CEO they are supposed to be overseeing might be particularly inclined to over pay that same CEO.Nonetheless, the Boston Globe just reported that other non-profit Massachusetts health insurers were defending their payme... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4670079 Sat, 02 Apr 2011 01:26:00 +0100 4670079 http://www.medworm.com/index.php?rid=4670080&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F04%2Fwendell-potter-on-insurers-cynical.html On his blog, Wendell Potter, former head of public relations for CIGNA, discussed big health insurance/ managed care organizations' attitudes toward paying financial penalties for wrong-doing:Having served as head of PR for two of the country’s largest health insurers — CIGNA and Humana — I know from personal experience that such fines are not widely considered newsworthy.Insurers know this, and so, annoying as being charged with breaking the law might be, they largely shrug off the fines and the threat of a day’s worth of bad publicity that occasionally accompany them. They are perfectly willing to risk being caught because they long ago realized that the fines are never severe enough to make them radically change the way they do business. Such a change would involve dealing more ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4670080 Fri, 01 Apr 2011 19:33:00 +0100 4670080 http://www.medworm.com/index.php?rid=4658348&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F03%2Fhow-large-health-care-organizations-set.html In conclusion, I strongly support Supri and Malone's final sentiments:The sum of the 'rules of the game' devised by these organizations has resulted in a fragmented, haphazard and broken system of health care. Reform is long overdue, and demands root and branch transformation of the 'rules of the game' governing the US institution of medicine. This requires us to understand these rules, who is setting them, and how these rules are being used to exploit the system of medicine. Only then can we begin to heal our ailing health care system.Well said!But now almost 8 years since the publication of "A Cautionary Tale," we still have a long way to go.References1.  Poses RM. A cautionary tale: the dysfunction of American health care.  Eur J Inte Med 2003; 14: 123-130.  Link here.2.&... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4658348 Wed, 30 Mar 2011 16:13:00 +0100 4658348 http://www.medworm.com/index.php?rid=4653284&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F03%2Fgovernment-run-health-insurance-run-by.html This article also noted:In the current system, the state pays three managed care companies set fees for each HUSKY and Charter Oak member every month, and the companies use the money to pay medical claims. Critics say it gives the managed care companies an incentive to deny care since they get to keep the money not spent on medical costs.So let us deal directly with the cognitive dissonance generated by these articles. In the ongoing US health reform debate, Medicaid is usually discussed as a "government-run" health care (insurance) program. Yet these news articles from Connecticut suggest at least in that state, part of Medicaid was out-sourced to mostly large, national, for-profit health insurance companies/ managed care organizations. Furthermore, as noted just above, these corporations... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4653284 Tue, 29 Mar 2011 18:34:00 +0100 4653284 http://www.medworm.com/index.php?rid=4592493&cid=t_454997_113_f&fid=34625&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FNeilVerselsHealthcareItBlog%2F%7E3%2FopWr_wehgR8%2F President Barack Obama has made plenty of mistakes in his first two-plus years in office, but none may be more serious for the future of America than his decision to install Donald M. Berwick, M.D., as a recess appointment to head the Centers for Medicare and Medicaid Services in July 2010. Berwick really is a great choice to head CMS, but the underhanded nature of the recess appointment has provided fodder for all kinds of uninformed ideologues and assorted nut jobs to attack Obama’s healthcare reform efforts. Just as CMS is gearing up to release widely anticipated proposed regulations for Accountable Care Organizations, we get the sad news that that Berwick’s days are numbered. After refusing to allow Berwick to testify before the Senate last year, Obama renominated Berwick on Jan. 2... Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=4592493 Mon, 14 Mar 2011 18:21:58 +0100 4592493 http://www.medworm.com/index.php?rid=4552049&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F03%2Frise-of-corporate-physician-end-of.html In discussing how concentration and abuse of power threatens health care professionals' values and professionalism, we have discussed how ostensibly academic institutions value faculty more for their earning power than their academic abilities.  We have discussed how financial relationships between physicians and drug, biotechnology, device and other companies risk abuse of entrusted power.  But up to now, I have been comforted by the hope that physicians in small independent practices who do not have such conflicts of interest are trying to uphold their professional values, even as they were buffeted by the perverse incentives imposed by managed care organizations/ health insurance companies and government insurance (e.g., US Medicare whose payments are controlled by the RUC).Ho... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4552049 Sat, 05 Mar 2011 16:48:00 +0100 4552049 http://www.medworm.com/index.php?rid=4545031&cid=t_454997_113_f&fid=34625&url=http%3A%2F%2Fwww.youtube.com%2Fv%2FNnYiPbIAzEQ%3Fhl%3Den%26amp%3Bfs%3D1 As has become custom at HIMSS, I sat down with Jonathan Bush, chairman, CEO and president of athenahealth, at the 2011 conference in Orlando, Fla., last week. But due to some technical difficulties in getting the room we thought we had reserved and in getting my audio recorder to work (OK, OK, I didn’t have fresh batteries on me), I busted out the HD video camera. (Wouldn’t you know, the battery was losing steam there, too, so I had to plug the camera in. I have since determined that the USB port wasn’t working, so I exchanged it this past weekend. But I seriously digress.) In this interview, we talk athena’s business, meaningful use, 5010/ICD-10, ACOs, cloud computing and health reform. We poke a little fun at the “boat show” that the vendor expo has be... Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=4545031 Mon, 28 Feb 2011 14:00:18 +0100 4545031 http://www.medworm.com/index.php?rid=4540615&cid=t_454997_113_f&fid=34625&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FNeilVerselsHealthcareItBlog%2F%7E3%2F3sJs3NGMVVU%2F Valentine’s Day came and went, but the love lingers with Health Wonk Review. Louise and Jay Norris have the Valentine’s Week edition of HWR at the Colorado Long Term Care Insider blog. They’ve included my recent podcast with Evan Steele of SRSsoft, and there’s plenty of other news about health insurance reform, Accountable Care Organizations and shared decision-making between patients and providers. Check it out. (Source: Neil Versel's Healthcare IT Blog) Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=4540615 Sat, 19 Feb 2011 15:00:07 +0100 4540615 http://www.medworm.com/index.php?rid=4477761&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmeasuring-the-patient-experience%2F2011.02.15 There’s a growing recognition within the medical-industrial complex that the patient is a key element of the enterprise, and that patient satisfaction, patient experience, patient engagement, patient activation, and patient-centeredness are very important. Some research shows that patient activation yields better patient outcomes, and that patient activation can be measured. Patient-centeredness and patient engagement are two of the key metrics to be used by the feds in describing Accountable Care Organizations (ACOs), if the internecine battles within government are resolved soon enough to actually release draft ACO regulations in time to allow for sufficient advance planning for the January 2012 go-live date. (Wearing one of my many hats, I’ve had the opportunity to submit ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4477761 Tue, 15 Feb 2011 14:00:44 +0100 4477761 http://www.medworm.com/index.php?rid=4459920&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F02%2Fpassport-to-fraud-amerihealth-mercy.html Back in November, 2010, we discussed the relatively opulent pay and perks given to and conflicts of interest affecting leaders of Passport Health Plan, a non-profit, state (Kentucky) supported Medicaid managed care organization/ health insurer.  This seemed to be another case of health care organizational insiders putting their personal gain ahead of their mission, which was particularly unseemly because their mission was serving the poor.  Now Passport Health is in the news again, and not in a favorable way, as per the Louisville (Kentucky) Courier-Journal:Passport Health Plan’s main contractor has agreed to pay more than $2 million in damages to the Kentucky Medicaid program to settle a fraud investigation, Attorney General Jack Conway announced Wednesday.The settlement with ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4459920 Thu, 10 Feb 2011 22:45:00 +0100 4459920 http://www.medworm.com/index.php?rid=4455262&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fintegrating-major-health-systems-could-make-things-worse%2F2011.02.09 Health reformers propose the proliferation of integrated health systems, like the Mayo Clinic or Kaiser Permanente, which, according to the Dartmouth Atlas, lead to better patient care and improved cost control. To that end, accountable care organizations (ACOs) have been a major part of health reform, changing the way healthcare is delivered. Never mind that patients may not be receptive to the new model, but the creation of these large, integrated physician-hospital entities that progressive policy experts espouse comes with repercussions. Monopoly power. To prepare for the new model of healthcare delivery, physician practices have been consolidating. In many cases, they’re being bought by hospitals. Last year, I wrote how this is leading to the death of the private practice physician... Better Health blogs http://www.medworm.com/rss/comments.php?id=4455262 Wed, 09 Feb 2011 22:00:58 +0100 4455262 http://www.medworm.com/index.php?rid=4414521&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-money-isnt-everything-to-doctors%2F2011.01.29 I recently pointed to a BMJ study concluding that pay for performance doesn’t seem to motivate doctors. It has been picking up steam in major media with TIME, for instance, saying: “Money isn’t everything, even to doctors.” So much is riding on the concept of pay for performance, that it’s hard to fathom what other options there are should it fail. And there’s mounting evidence that it will. Dr. Aaron Carroll, a pediatrician at the University of Indiana, and regular contributor to KevinMD.com, ponders the options. First he comments on why the performance incentives in the NHS failed: Perhaps the doctors were already improving without the program. If that’s the case, though, then you don’t need economic incentives. It’s possible the incentives were too low. But I don’t... Better Health blogs http://www.medworm.com/rss/comments.php?id=4414521 Sat, 29 Jan 2011 17:00:01 +0100 4414521 http://www.medworm.com/index.php?rid=4394444&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-the-end-of-internal-medicine-as-we-know-it-might-be-a-good-thing%2F2011.01.24 A recent post on the Health Affairs blog proclaimed “The End of Internal Medicine As We Know It.” What the post is really asking about is the future of primary care in the world of healthcare reform and the creation of accountable care organizations (ACOs). While doctors should be naturally concerned about change, I don’t completely agree with this article. ACOs are organizations that are integrated and accountable for the health and well-being of a patient and also have joint responsibilities on how to thoughtfully use a patient’s or employer’s health insurance premium, something that is sorely lacking in the current health care structure. These were recently created and defined in the healthcare reform bill. Yet the author seems to suggest that this is a s... Better Health blogs http://www.medworm.com/rss/comments.php?id=4394444 Mon, 24 Jan 2011 20:00:00 +0100 4394444 http://www.medworm.com/index.php?rid=4349515&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Freferral-communication-what-happens-to-handoffs-between-primary-care-physicians-and-specialists%2F2011.01.14 Far more primary care doctors report detailed referrals than do specialists report receiving them. The same applies in reverse. Specialists report returning quality consultations, while primary care physicians report receiving them far less often. Researchers reported in Archives of Internal Medicine that perceptions of communication regarding referrals and consultations differed widely. While 69.3 percent of primary care physicians reported “always” or “most of the time” sending a patient’s history and the reason for the consultation to specialists, only 34.8 percent of specialists said they “always” or “most of the time” received the information. And, while 80.6 percent of specialists said they “always” or “most o... Better Health blogs http://www.medworm.com/rss/comments.php?id=4349515 Fri, 14 Jan 2011 18:00:00 +0100 4349515 http://www.medworm.com/index.php?rid=4331016&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ffirst-report-from-the-society-of-participatory-medicines-newly-appointed-public-policy-committee-chair-david-harlow%2F2011.01.10 In December, the Society for Participatory Medicine’s executive committee appointed health law attorney David Harlow to represent the Society in public policy matters. Regular readers of HealthBlawg::David Harlow’s Health Care Law Blog know what a patient-centered, participatory thinker David is. This is his first report. I am delighted to offer my first report as Public Policy Committee Chair for the Society of Participatory Medicine. I encourage all of you who are not yet Society members to join, and I encourage new and old members to consider volunteering to help with the wide range of public policy issues facing us today. Over the past couple of months, the Public Policy Committee has gotten its sea legs. We are beginning to add the Society’s voice to the national discourse on p... Better Health blogs http://www.medworm.com/rss/comments.php?id=4331016 Mon, 10 Jan 2011 14:00:15 +0100 4331016 http://www.medworm.com/index.php?rid=4272289&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-musical-chairs-of-medical-speciality%2F2010.12.19 The consolidation of physician specialty practices into larger corporate healthcare systems in urban areas is creating a new challenge for today’s doctors when the music stops: There might not be a chair available. There are simply many fewer hospital systems in large urban areas than there are specialy practices, so the number of specialist positions a large healthcare system is willing to absorb might be limited. As doctors and hospital systems coalesce into as-yet-to-be-clearly-defined “accountable care organizations,” the cost of too many specialists in an organization is being carefully weighed. (more…) *This blog post was originally published at Dr. Wes* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4272289 Sun, 19 Dec 2010 20:00:00 +0100 4272289 http://www.medworm.com/index.php?rid=4272293&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F11-healthcare-predictions-for-2011%2F2010.12.18 Here are 11 things that are absolutely going to happen* in 2011 (they’re in no particular order….or are they?): 1.  There will be no big compromise between President Obama and the Republicans on healthcare reform. Why? Because the law is such a massive collection of, well, stuff, that it is pretty much impossible to find pieces of it that you could cut a deal on, even if you wanted to. And no, the federal district court decision on the individual mandate doesn’t change my mind…and in fact may breathe new life into other parts of the law). State governments, insurance companies, and private businesses have made all kinds of important and hard to reverse choices based on the law as is. There’s not much of an appetite outside of people trying to score political points for m... Better Health blogs http://www.medworm.com/rss/comments.php?id=4272293 Sat, 18 Dec 2010 20:00:44 +0100 4272293 http://www.medworm.com/index.php?rid=4249056&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnewt-gingrichs-take-on-facebook-saving-a-womans-life%2F2010.12.10 I’ve seen at least half a dozen links to the op-ed coauthored by Newt Gingrich and neurosurgeon Kamal Thapar about how the doctor used information on Facebook to save a woman’s life. (It was published by AOL News. Really.) In brief, a woman who had been to see a number of different health care providers without getting a clear diagnosis showed up in an emergency room, went into a coma and nearly died. She was saved by a doctor’s review of the detailed notes she kept about her symptoms, etc., which she posted on Facebook. The story is vague on the details, but apparently her son facilitated getting the doc access to her Facebook page, and the details posted there allowed him to diagnose and treat her condition. She recovered fully. Newt and Dr. Thapar wax rhapsodic about... Better Health blogs http://www.medworm.com/rss/comments.php?id=4249056 Fri, 10 Dec 2010 23:00:54 +0100 4249056 http://www.medworm.com/index.php?rid=4225183&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F12%2Fhealth-insurers-sanctioned-fined.html It has not been a good few weeks for big US health insurance companies.  First was a report (e.g., per the Wall Street Journal) that three companies had been suspended from selling Medicare Advantage plans:The U.S. government's Medicare program has ordered three health insurers--Universal American Corp. (UAM), Health Net Inc. (HNT) and Arcadian Health--to stop marketing to and enrolling new members in their Medicare Advantage health and prescription-drug plans, saying the companies violated regulations. In particular,Universal American was told to stop marketing to and enrolling people in its Medicare Advantage plans effective Dec. 5. The action doesn't affect current members or the enrolling of beneficiaries in the company's stand-alone Medicare prescription-drug plans.Health Net had... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4225183 Fri, 03 Dec 2010 17:03:00 +0100 4225183 http://www.medworm.com/index.php?rid=4203141&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F11%2Faco-arrogant-clinical-or-aggressive.html In the 1970s, it was managed care organizations.  In the 1990s, it was vertically integrated health care systems.  In the 2010s, the fashionable concept for improving health care, apparently beloved by left-wing policy wonks and right-wing health care executives is the "accountable care organization." (ACO).  Development of the ACO is funded by the recently passed US health care reform legislation.  The official definition of ACO from the US Center for Medicare and Medicaid Services is:  An Accountable Care Organization, also called an 'ACO' for short, is an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program w... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4203141 Fri, 26 Nov 2010 17:51:00 +0100 4203141 http://www.medworm.com/index.php?rid=4167923&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F11%2Fliving-high-life-on-money-to-treat-poor.html Here is another story that has developed over the last week about questionable goings on at a not-for-profit health care organization.  The organization in question this time was the not-for-profit, but state government supported Medicaid managed care organization/ health insurer for the Louisville, Kentucky region.  The details came from a Louisville (Kentucky) Courier-Journal article about a state auditor's report on the Passport Health Plan:The organization providing Medicaid services in Jefferson and surrounding counties has spent lavishly on such things as travel, meals, salaries, bonuses and lobbying in recent years, the state auditor’s office said in a report released Tuesday.The scathing report, which Gov. Steve Beshear described as 'disheartening,' said two Passpo... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4167923 Mon, 15 Nov 2010 21:49:00 +0100 4167923 http://www.medworm.com/index.php?rid=4167961&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Froadmap-for-new-physicians-how-to-avoid-fraud-and-abuse%2F2010.11.15 In October, the Office of Inspector General (OIG) issued a report on Fraud and Abuse Training in Medical Education, finding that 44 percent of medical schools reported giving some instruction in the anti-kickback statute and related laws, even though they weren’t legally required to do so. (As an aside, do we really live in such a nanny state? Over half of all medical schools don’t teach their students anything about this issue — because nobody’s making them — even though it is an issue that looms large in the practice of medicine.) On a more positive note, about two-thirds of institutions with residency programs instruct participants on the law, and 90 percent of all medical schools and training programs expressed an interest in having dsome instructional... Better Health blogs http://www.medworm.com/rss/comments.php?id=4167961 Mon, 15 Nov 2010 13:00:16 +0100 4167961 http://www.medworm.com/index.php?rid=4105669&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-new-healthcare-law-so-sad-its-funny%2F2010.10.25 Thanks to Scott Hensley over at Shots, NPR’s Health Blog, for highlighting this sad but funny video on where we’re going with healthcare. Scary what happens when theory meets reality: -WesMusings of a cardiologist and cardiac electrophysiologist. *This blog post was originally published at Dr. Wes* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4105669 Mon, 25 Oct 2010 13:00:00 +0100 4105669 http://www.medworm.com/index.php?rid=4082093&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Facos-the-gathering-storm%2F2010.10.18 Those of you who’ve read this blog for any length of time know that I have been a pretty strong advocate for healthcare reform. This has been primarily motivated by my passion for universal coverage, but also with my frustration with the cost of the current healthcare system, the generally crummy outcomes, and the overall level of fragmentation in the whole affair. Even today, I had to repeat blood tests on a cancer patient who came to the ER. He had had blood tests at the cancer center ACROSS THE STREET before presenting, but, so sorry, our computers don’t talk to theirs and it’s after 5pm now, so forget about getting those results.  So it’s with a mixture of enthusiasm and dread that I consider the coming onslaught of accountable care organizations (ACOs). What ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4082093 Mon, 18 Oct 2010 19:00:00 +0100 4082093 http://www.medworm.com/index.php?rid=4031244&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Faccountable-care-organizations-global-payments-to-replace-fee-for-service%2F2010.10.04 Federal health reform and Massachusetts health reform may find a point of convergence in the development of ACOs (accountable care organizations) and the payment mechanisms that will make them tick (or hum, or do whatever it is that we want them to do).  The Federales will be holding a listening session next week on the issues raised by ACOs across the HHS and FTC landscapes.  Meanwhile, back in Boston, the inner circle of health care regulators and the regulated community are busy hashing out an approach to global payments that could be ready for prime time by January 1. The need for payment reform in Massachusetts has been well-documented — see the health care market report from the AG’s office, as well as an earlier report on the imperative to keep insurance risk on insure... Better Health blogs http://www.medworm.com/rss/comments.php?id=4031244 Mon, 04 Oct 2010 16:00:22 +0100 4031244 http://www.medworm.com/index.php?rid=4018178&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-governments-involvement-in-new-primary-care-models%2F2010.09.30 Government healthcare reform efforts are picking up the pace to roll out new reimbursement and practice models for primary care. Medicare is giving out $10 billion for pilot projects encouraging new models of primary care, including the patient-centered medical home. New Jersey just passed legislation to explore the patient-centered medical home. Now, Massachusetts, the early adopter of mandatory health insurance, is now ambitiously planning how to take on the fee-for-service reimbursement system and moving toward accountable care organizations. Under discussion are the scope of power for state regulators, what rules will apply to accountable care organizations, and how to get rid of the existing fee-for-service system. Blogger and pediatrician Jay Parkinson, MD, MPH, comments about the &#... Better Health blogs http://www.medworm.com/rss/comments.php?id=4018178 Thu, 30 Sep 2010 12:00:00 +0100 4018178 http://www.medworm.com/index.php?rid=3895888&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Faccountable-care-and-doctor-patient-communication-go-hand-in-hand%2F2010.08.23 Accountable Care Organizations (ACOs) figure prominently in the new Patient Protection and Affordable Care Act (PPACA). The concept behind ACOs is that by tying both physician and hospital compensation to outcomes via a bundled fee (say for pneumonia) we can expect to see an improvement in quality and value. In principal, accountable care makes a lot of sense. Practicality speaking, however, doctors and hospitals must address a huge challenge before they can expect benefit financially. Before doctors can be held accountable for the care they deliver, they must first be held accountable for the quality of their communication with patients. Take hospital readmissions, which are a big healthcare cost driver today. According to a recent study in the New England Journal of Medicine, 20 perce... Better Health blogs http://www.medworm.com/rss/comments.php?id=3895888 Mon, 23 Aug 2010 18:00:39 +0100 3895888 http://www.medworm.com/index.php?rid=3889048&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F08%2Fhow-oligopolists-rationalize-their.html Advocates of laissez faire commercialized health care often trumpet the advantages of competitive markets as a rationale for deregulation.  While there are theoretic, and possibly empiric reasons to think that competitive markets are the optimal way to distribute goods and services, we recently discussed aspects of health care that make it extremely hard for health care markets to be ideally competitive.  Meanwhile, two news articles gave some case-based evidence about how current health care markets are hardly competitive.   Sutter HealthA Bloomberg article focused on Sutter Health in northern and central California. Sutter Health commands a substantial part of a very large market:Sutter Health Co., the nonprofit that owns Sutter Davis, has market power that commands p... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3889048 Fri, 20 Aug 2010 20:17:00 +0100 3889048 http://www.medworm.com/index.php?rid=3721731&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F07%2Fwellcare-settles-again-but-wait-there.html We posted several times, most recently in 2009 (here and here), about misbehavior by the health insurance company/ managed care organization Wellcare.  That year, the company settled criminal charges that it defrauded the Florida state Medicaid program by paying a fine and accepting a deferred prosecution agreement.  Previously, the state of Connecticut had canceled its arrangement with Wellcare to run a Medicaid program in that state after the company refused to provide the state with requested data.  Then the company signed a consent order with the Florida Elections Commission in which it admitted making "questionable" political contributions.Then this year, it was announced that the company would settle additional civil charges, as per the St. Petersburg (FL) Times, Tampa... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3721731 Fri, 02 Jul 2010 16:13:00 +0100 3721731 http://www.medworm.com/index.php?rid=3641022&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealthcare-reform-motivating-self-responsibility-in-patients%2F2010.06.07 Last week I heard a lecture about Accountable Care Organizations by a physician leader working for one of the major hospital systems. His discussion made me realize that large physician organizations and hospitals are spending lots of time solving problems of quality medical care. In my opinion quality medical care has not been adequately defined. A working definition right now is to decrease hospital stays, efficient medical care for a disease at lower cost, avoidance of medical errors in the hospital, and avoidance of hospital acquired infections. These are important goals. They must be attached to monetary incentives. Many of these problems can be solved now. The solution demands the development of processes of care. An important question is how much money will process improvement save?... Better Health blogs http://www.medworm.com/rss/comments.php?id=3641022 Mon, 07 Jun 2010 21:00:05 +0100 3641022 http://www.medworm.com/index.php?rid=3603596&cid=t_454997_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ffrom-winnie-the-pooh-edward-bear-and-primary-care%2F2010.05.26 Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it.  – From A.A. Milne’s “Winnie the Pooh and the House at Pooh Corner.” Internists, I expect, will identify with Edward Bear. Richard Baron’s study in the NEJM on the amount of work he and his colleagues do outside of an office visit — the “bump, bump, bump” of a busy internal medicine (IM) practice — has resonated with many of his colleagues. Jay Larson, who often posts comments on this blog, did a similar analysis for his general IM practice in Monta... Better Health blogs http://www.medworm.com/rss/comments.php?id=3603596 Wed, 26 May 2010 14:00:00 +0100 3603596 http://www.medworm.com/index.php?rid=3529731&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F05%2Fboard-member-blows-whistle-on-health.html We previously posted about some of the travails of for-profit health insurance company/ managed care organization Wellcare.  In August, 2009, we posted about Wellcare's "admission" that it had made numerous questionable campaign contributions.  In May, 2009 we posted about WellCare's submission to a deferred prosecution agreemeent based on charges that it defrauded state programs by inflating its expenses. In 2007, we posted about how the state of Connecticut stopped WellCare from running a plan for poor children after the company refused to reveal what it was paying physicians, and why it was failing to pay for particular services. So WellCare has been cited for three different kinds of unethical behavior in 2007-09. Here's a story about Wellcare with a new twist ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3529731 Mon, 03 May 2010 20:32:00 +0100 3529731 http://www.medworm.com/index.php?rid=3501494&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F04%2Fpay-for-hypocrisy-for-health-insurance.html A few weeks ago, we discussed the cognitive dissonance produced by huge salary boosts for top executives of health care companies with miserable ethical track records.  One of our examples contrasted a long list of ethical violations by US giant health insurance company/ managed care organization WellPoint and the huge raises given its CEO and top executives.  Now more ethical questions are being raised about WellPoint.Rate Hikes Retrospectively for Golden ParachutesAn op-ed published in several California newspapers (here via the Sonoma Index-Tribune) claimed that the huge rate hike that WellPoint's California subsidiary proposed earlier this year, an action that helped to revitalize the US legislative health care reform process, was meant to recoup costs of a pre... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3501494 Fri, 23 Apr 2010 20:09:00 +0100 3501494 http://www.medworm.com/index.php?rid=3302278&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F02%2Fargument-over-insurance-rate-hikes.html There has been a tremendous amount of news coverage of a large rate increase proposed by Anthem Blue Cross, a subsidiary of WellPoint, in California.  For example, the Los Angeles Times reported last week,Congress opened an investigation Tuesday into Anthem Blue Cross' impending rate increases in California as President Obama cited the premium hikes -- some as high as 39% -- in his bid to pass national healthcare legislation.The House Committee on Energy and Commerce and its Subcommittee on Oversight and Investigations announced they were examining the increases, which are set to take effect March 1. The subcommittee has scheduled a Feb. 24 hearing in Washington, while an Assembly committee in Sacramento has set a hearing for Feb 23.'Reports of premium increases up to 39% are dee... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3302278 Wed, 24 Feb 2010 17:30:00 +0100 3302278 http://www.medworm.com/index.php?rid=2912143&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F10%2Fnews-flash-1945-law-allows.html Last week, some media reports noted that US Congressional Democrats countered an insurance industry study suggesting health care reform would cost much more than estimated by threatening a repeal of the McCarran-Ferguson Act's anti-trust exemption for health insurance. For example, in the New York Times Prescriptions Blog:In a rare appearance as a witness at a Senate hearing, the majority leader, Harry Reid of Nevada, told the Judiciary Committee on Wednesday that it should repeal a 1945 law that granted the insurance industry limited exemption to national antitrust laws by allowing states to regulate insurers.The law, the McCarran-Ferguson Act, is often cited by Mr. Reid and other critics of the health insurance industry as a reason why coverage can be so expensive for many people. They s... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2912143 Tue, 20 Oct 2009 23:26:00 +0100 2912143 http://www.medworm.com/index.php?rid=2730068&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F08%2Fwellcare-did-not-contest-that-its.html From a report in the St Petersburg (Florida) Times:WellCare Health Plans on Wednesday admitted to making 129 'questionable' contributions to Florida politicians over four years ending in 2007. In a consent order with the Florida Elections Commission, the Tampa-based managed-care company agreed to pay a $120,000 fine and did not contest the commission's finding of probable cause that the contributions violated state law.The Associated Press reported in February that WellCare, its subsidiaries and executives spent $2.4 million in political contributions in the 2004 and 2006 elections. More than 95 percent went to Republicans, who pushed a plan to send more state and federal Medicaid spending through private companies like WellCare.In May, 2009 we posted about WellCare's submission to a defer... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2730068 Mon, 24 Aug 2009 19:13:00 +0100 2730068 http://www.medworm.com/index.php?rid=2648991&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F07%2Fare-health-plans-of-very-rich-different.html Yesterday, the New York Times published an intriguing story about "Cadillac" (that is, expensive) health insurance plans,Goldman Sachs is one of the nation’s richest banks, and hundreds of top Goldman employees have a health care package to match — one of the 'gold-plated Cadillac' plans cited by those involved in the health care debate in Washington.Goldman’s 400 or so managing directors and its top executive officers participate in the bank’s executive medical and dental program as part of their benefits, according to documents filed with the Securities and Exchange Commission. The program generally costs the bank $40,543 in premiums annually for each participant’s family.Those taking part in the plan include the company’s chief executive, Lloyd C. Blankfein, and four other t... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2648991 Tue, 28 Jul 2009 20:50:00 +0100 2648991 http://www.medworm.com/index.php?rid=2510435&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F06%2Fmanaged-care-executives-will-not-limit.html We have posted before about how certain health care insurance companies/ managed care organizations in California were found to have cancelled individual health insurance policies after the people holding them made substantial claims, supposedly rationalized by minor errors or omissions in the information the people supplied to the companies on their individual applications found after the claims were made. Several companies were subsequently disciplined by the state government for these "rescissions." See posts on rescissions by WellPoint here, here, and here, and by Health Net here.Executives of several such companies testified before a US congressional committee recently, with remarkable results, as reported by Lisa Girion writing in the Los Angeles Times. First, by way of background, t... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2510435 Fri, 19 Jun 2009 19:13:00 +0100 2510435 http://www.medworm.com/index.php?rid=2510437&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F06%2Fpharmacy-benefit-managers-as.html We posted a number of times about questionable practices Eli Lilly used to market its atypical anti-psychotic drug Zyprexa (olanzapine). A post from 2007, with links backward, is here, and our most recent post is here. The company remains entangled in litigation over its marketing of this drug. That litigation has lead to the release of numerous internal documents that provide quite a view of Lilly's marketing practices. Bloomberg continued its reporting on these documents, with its latest effort here via the Boston Globe, describing yet another surprising way this drug was sold:A unit of CVS Caremark Corp. used its access to doctors to market Eli Lilly & Co.'s Zyprexa antipsychotic while it was under contract to bargain with the drug maker on behalf of health insurers, internal Lilly ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2510437 Wed, 17 Jun 2009 01:00:00 +0100 2510437 http://www.medworm.com/index.php?rid=2200463&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F02%2Fwellpoint-settles.html As reported by the Indianapolis Star (among others), the large health insurance company/ managed care organization WellPoint is the latest company to settle charges related to its use of a questionable data-base to determine payments for out of network care:WellPoint has agreed to pay $10 million to settle an investigation by New York Attorney General Andrew Cuomo into questionable insurance reimbursements in that state.The Indianapolis-based insurer becomes the seventh major health benefits company to settle in what authorities called an industrywide scheme to defraud consumers.Cuomo charged the insurers with setting artificially low reimbursement rates to doctors who weren't in their health networks.At the heart of the investigation is Ingenix, a unit of insurance giant UnitedHealth Grou... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2200463 Thu, 19 Feb 2009 22:44:00 +0100 2200463 http://www.medworm.com/index.php?rid=2160333&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F02%2Faetna-settles.html As reported by the Hartford Courant:Aetna will reimburse more than $5.1 million on 73,000 health claims for college students it underpaid between 1998 and April 1, 2008, under a nationwide agreement announced Monday by New York Attorney General Andrew M. Cuomo.The claims involved out-of-network care in which Aetna Student Health — formerly called Chickering Student Health — paid physicians what it considered reasonable and customary. Doctors whose charges were higher could bill students for the balance.Aetna will reimburse students if they paid such a balance. If a student wasn't balance-billed, Aetna will reimburse the doctor. The company says its under-payments averaged $25 each nationwide.The inadequate claim payments stem from outdated information that Aetna and other insurers used... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2160333 Wed, 04 Feb 2009 22:07:00 +0100 2160333 http://www.medworm.com/index.php?rid=2104436&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F01%2Fwellpoint-sanctioned.html Giant insurance company/ managed care organization WellPoint was just sanctioned by the US government. As reported by the Wall Street Journal,Federal officials temporarily banned health insurer WellPoint Inc. from marketing or selling Medicare health or drug plans after they said computer problems caused it to deny thousands of seniors coverage for vital medications and cancel their benefits.The ban, effective late Monday, is one of the toughest penalties levied on a private Medicare plan provider since the introduction of the government program's drug benefit three years ago.In an unusually terse letter to WellPoint, the government agency that oversees Medicare said the company's 'longstanding and persistent failure to comply with [Medicare] requirements' had begun to pose 'a serious thre... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2104436 Wed, 14 Jan 2009 20:58:00 +0100 2104436 http://www.medworm.com/index.php?rid=2104437&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F01%2Funitedhealth-and-ingenix-settles.html UnitedHealth just settled yet another lawsuit. As reported by the New York Times,In a settlement with one of the nation’s biggest insurers, New York’s attorney general, Andrew M. Cuomo, has ordered an overhaul of the databases the industry uses to determine how much of a medical bill is paid when a patient uses an out-of-network doctor.A statement from Mr. Cuomo’s office said the industry had engaged in 'a scheme to defraud consumers' by systematically underpaying the nation’s patients by hundreds of millions of dollars over the last decade.The move, to be announced Tuesday, is part of a settlement with the insurance giant UnitedHealth Group, which operates the industry databases. It results from a yearlong investigation by Mr. Cuomo’s office that concluded the data had understat... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2104437 Wed, 14 Jan 2009 20:13:00 +0100 2104437 http://www.medworm.com/index.php?rid=2095837&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F01%2Fis-care-delayed-tantamount-to-care.html Justice delayed is justice denied, as the saying goes.  By the same token, does it not hold that treatment delayed is treatment denied?  And thus are not risks increased, treatment outcomes compromised, sufferings magnified?  Call me Ishmael. My partners and I operate a large psychiatric practice on the outskirts of a mid-sized Northeastern city.  Our patient population comprises a representative spectrum of the local community, from early adolescents on up.  Within our specialty, we are the face of American healthcare.  Among the many machinations concocted by the managed care entities through the years, we suspect that a new one has recently been given birth.  It might well be dubbed “managed delays.”  In the good old days of insurance company SOP, especially among the for-p... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2095837 Sun, 11 Jan 2009 19:03:00 +0100 2095837 http://www.medworm.com/index.php?rid=2086898&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F01%2Fto-whom-did-scorpions-in-bottle-owe.html In 2000, an important meeting took place between two men.The first was a member of the board of directors of Merck Inc, the global pharmaceutical company, and of the board of Charles River Laboratories, which helps "our global partners accelerate drug discovery and development by providing them with tailored research models and preclinical, clinical, support services." The second was a member of the board of IMH Health, which advertises that it provides "global information, analytics and consulting" to support "the life cycle of medicines," from "the earliest stages of research and development through product launch, product maturation and patent expiration," and on the board of BankBoston Corporation, a national and international bank holding company. What might they have talked about?It ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2086898 Wed, 07 Jan 2009 19:49:00 +0100 2086898 http://www.medworm.com/index.php?rid=2081039&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F01%2Fscorpions-in-bottle-shook-hands-secret.html The Boston Globe just published a series of investigative reports about a case that illustrates what went wrong with last 20 years' paradigm of health care reform. Remember how business-like management and competition were going to control health care costs (while improving quality and access)?The reports focus on how Partners Healthcare, the health care system formed from the merger of the Massachusetts General Hospital and the Brigham and Women's Hospital, was able to use its position and prestige to improve its reimbursement. The key points from the key article:- The merger occurred in a climate of deregulation and laissez faire, based on the theory that managed care would damp down hospital costsFormed in an era of fervent deregulation, Partners has benefited throughout its history fro... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2081039 Mon, 05 Jan 2009 21:12:00 +0100 2081039 http://www.medworm.com/index.php?rid=2017515&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F12%2Fblogscan-insuring-right-to-buy-health.html On the Covert Rationing Blog, DrRich discussed the latest amazing product from our friends at UnitedHealth. Called Continuity, it allows people who are currently healthy to buy the right to buy health insurance in the future, presumably at a time when they might not be healthy, and hence would not be able to meet the sort of stringent underwriting requirements that most companies now impose on those seeking individual health insurance. Thus, this product is sort of second order insurance, insurance on insurance, or, as DrRich puts it a hedge on the future risk of uninsurability. DrRich's incisive post argued that the offering of such a product suggests that UnitedHealth is betting that it will be out of the health insurance business in the near future, put out of business by some new natio... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2017515 Sat, 06 Dec 2008 21:29:00 +0100 2017515 http://www.medworm.com/index.php?rid=1901415&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F10%2Fif-this-is-how-wellpoint-has-managed.html Among other news outlets, the Indianapolis Star reported that giant health care insurance company/ for-profit managed care organization WellPoint has had trouble with its investment portfolio:WellPoint is like many other investors these days: Its portfolio took a sizable hit from the financial crisis.The Indianapolis-based health insurance giant saw its quarterly profit fall 5.4 percent, dragged down by investment losses.The company Wednesday reported a profit of $820.7 million for the third quarter ending Sept. 30. That's down from a profit of $868 million a year earlier. WellPoint's quarterly revenue of about $15 billion also was down slightly from a year ago.WellPoint said that those results included pre-tax investment losses of $562.6 million, or 71 cents a share. Of those losses, $229... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1901415 Thu, 23 Oct 2008 15:30:00 +0100 1901415 http://www.medworm.com/index.php?rid=1652286&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F07%2Famerigroup-settles.html Another addition to the cavalcade of settlements, from the Virginian-Pilot,Amerigroup Corp., which faced $334 million of damage awards and court-imposed penalties from a Medicaid fraud suit in Chicago, said Tuesday that it will pay the U.S. government and state of Illinois $225 million to settle the civil case.As part of an agreement struck with federal and state agencies, the Virginia Beach-based health insurer said it also will pay $9 million in legal fees, but it will not admit any wrongdoing.However, Amerigroup said it also will enter into a corporate-integrity agreement with the inspector general of the Department of Health and Human Services, the federal agency that provides part of the funding for state Medicaid programs.The suit's plaintiffs - a former Amerigroup employee, the stat... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1652286 Thu, 24 Jul 2008 14:31:00 +0100 1652286 http://www.medworm.com/index.php?rid=1645890&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F07%2Ffines-re-statements-and-more-fines-just.html Several related stories about commercial managed care organizations/ health insurers surfaced recently.First, as reported by Lisa Girion in the Los Angeles Times,Anthem Blue Cross and Blue Shield -- two of the state's biggest health plans -- agreed Thursday to pay a total of $13 million in fines and to offer new health coverage to more than 2,200 Californians the companies dropped after they became ill.Neither company admitted to any wrongdoing in agreeing to pay the stiffest penalties yet in efforts by state authorities to curb what they view as an abusive practice of investigating and canceling policies after policyholders run up big medical bills.Blue Cross, a unit of Indianapolis-based WellPoint Inc., will pay a $10-million fine to the state Department of Managed Health Care, and it wi... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1645890 Tue, 22 Jul 2008 21:22:00 +0100 1645890 http://www.medworm.com/index.php?rid=1605870&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F07%2Fwellpoint-settles-but-has-it-become-too.html We just posted about the latest travails of the UnitedHealth Group, a for-profit managed care organization founded by one of the early advocates of managed care as the cure for health care problems. Lately, the company has been better known for the lavish compensation it gave its former CEO.Another large, for-profit managed care organization/ health insurer has also lately been in the news, and not in favorable terms. We have previously discussed how Wellpoint Inc and/or its subsidiaries:misplaced a computer disc containing confidential information on 75,000 policy-holders (see post here) settled a RICO (racketeer influenced corrupt organization) law-suit in California over its alleged systematic attempts to withhold payments from physicians (see post here) was fined for cancelling individ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1605870 Thu, 10 Jul 2008 19:47:00 +0100 1605870 http://www.medworm.com/index.php?rid=1596343&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F07%2Funitedhealth-settles.html We had posted often (see these posts here, here, and here from 2006 with links backward) about the hugely lavish compensation afforded to the Dr William McGuire, former CEO of UnitedHealth Group, one of the largest US insurers/ managed care organizations, and how this remuneration stood in stark contrast to the (older version of the) stated mission of UnitedHealth Group:UnitedHealth Group is a diversified health and well-being company dedicated to making the health care system work better. The company directs its resources into designing products, providing services and applying technologies that:- Improve access to health and well-being services;- Simplify the health care experience;- Promote quality; and,- Make health care more affordable.Most recently, controversy has swirled over the t... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1596343 Tue, 08 Jul 2008 21:37:00 +0100 1596343 http://www.medworm.com/index.php?rid=1454325&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F05%2Fcommercial-managed-care-organizations.html In the American Medical News is a revealing article about large commercial managed care organizations (MCOs):The nation's largest publicly traded health plans say they don't plan to temper premium increases for the sake of keeping members on their rolls -- particularly not while they are under pressure from Wall Street over what it sees as their disappointing earnings.Wall Street analysts were shaken over the long-term prospects of the health plan business after bellwethers WellPoint and UnitedHealth Group, the nation's two largest private-pay plans, reported less-than-expected profits from the first three months of this year.But health insurers say cutting premiums or reducing the rate of increase to keep customers would affect their bottom lines more than losing some members over premium... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1454325 Mon, 19 May 2008 20:22:00 +0100 1454325 http://www.medworm.com/index.php?rid=1253211&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F02%2Fjudge-cites-health-nets-egregious-and.html More than two years ago, we noted that Health Net Inc,, the large US health insurer/ for-profit managed care organization, had settled a class-action lawsuit brought by California physicians under the RICO (Racketeer Influenced and Corrupt Organizations) standard. Late last year, we noted that HealthNet was fined by the state of California for offering bonuses to employees who retroactively cancelled the most individual health policies after their holders got sick and filed claims, and that the company was under investigation in Connecticut for allegedly sending deceptive messages to pharmacists that denied payment for some low-income childrens' medication.Last week, Florida Health News reported,Medicare officials have ordered Health Net, Inc., one of the largest publicly traded health ins... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1253211 Mon, 25 Feb 2008 05:18:00 +0100 1253211 http://www.medworm.com/index.php?rid=1230297&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F02%2Fwellpoint-halts-attempts-to-have.html We just discussed the sorry state of Merck Inc, whose founder once said, "Medicine is for people, not for profits," but now seems to be run by people who think otherwise, to the detriment not only of patients, but of the company and most of its employees.Here is another example of a company that seems to put short-term financial gain ahead of its stated commitment to "improving ... lives."Lisa Girion, writing in the Los Angeles Times, reported yesterday that Blue Cross of California, a subsidiary of for-profit Wellpoint Inc, has been "asking California physicians to look for conditions it can use to cancel their new patients' medical coverage." In particular,Blue Cross of California is sending physicians copies of health insurance applications filled out by new patients, along with a lette... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1230297 Wed, 13 Feb 2008 19:59:00 +0100 1230297 http://www.medworm.com/index.php?rid=1188558&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F01%2Fbungled-not-brilliant-results-of.html We had posted often (see these posts here, here, and here from 2006 with links backward) about the hugely lavish compensation afforded to the Dr William McGuire, former CEO of UnitedHealth Group, one of the largest US insurers/ managed care organizations, and how this remuneration stood in stark contrast to the stated mission of UnitedHealth Group:UnitedHealth Group is a diversified health and well-being company dedicated to making the health care system work better. The company directs its resources into designing products, providing services and applying technologies that:- Improve access to health and well-being services;- Simplify the health care experience;- Promote quality; and,- Make health care more affordable.Most recently, controversy has swirled over the timing of huge stock opt... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1188558 Wed, 30 Jan 2008 16:04:00 +0100 1188558 http://www.medworm.com/index.php?rid=1182766&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F01%2Fmore-managed-care-management-mumbo.html A number of news items about managed care organizations/ health insurers published last week make for an interesting juxtaposition.Innovative Physician Reimbursement?First were articles about managed care proposals for innovative physician reimbursement. First, from the Boston Globe, an article about a proposal to resurrect capitation.Massachusetts' dominant health insurer is proposing to overhaul the way it pays doctors and hospitals, in what company officials said is an attempt to slow runaway healthcare costs and improve the quality of care.Blue Cross and Blue Shield of Massachusetts wants to stop paying doctors and hospitals for each patient visit or treatment, a common arrangement that most experts agree has led to unnecessary, inefficient, and fragmented care that is sometimes harmfu... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1182766 Mon, 28 Jan 2008 18:34:00 +0100 1182766 http://www.medworm.com/index.php?rid=1126147&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F01%2Fblogscan-case-of-liver-transplant-that.html On the Health Beat blog, Maggie Mahar dissected the complex and unfortunate case of a teenager who died shortly after her family's health care insurer rejected paying for a proposed liver transplant in desperate circumstances. Ms Maher brought up a host of issues and questions that did not surface in discussion in the main stream media. The one I thought was most relevant to Health Care Renewal: given how sick this patient was, if the physicians and hospital administrators involved thought a transplant was so urgently needed, why weren't they willing to go ahead with the procedure in the absence of a $75,000 down-payment by the patient's family? (Source: Health Care Renewal) Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1126147 Wed, 02 Jan 2008 20:08:00 +0100 1126147 http://www.medworm.com/index.php?rid=1108574&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F12%2Fmanaged-care-ceo-takes-closer-look-at.html We have posted frequently, most recently here and here, about the RBRVS Update Committee's (RUC) responsibility for Medicare's relatively poor reimbursement of primary care and other "cognitive" physicians' services compared to procedures. Although the AMA claims that the RUC is just an "expert panel," it appears de facto to be the only source of input to Medicare about how to revise physicians' reimbursement. However, rather than operating transparently so as to represent the views of at least the broad physician community, the committee's proceedings are secret, as are the names of its current members, who mainly represent surgical sub-specialties. Concern about the RUC has been more evident in the blogsphere, if not openly anywhere else. Most recently, the issue was noted on the Let's T... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1108574 Thu, 20 Dec 2007 15:21:00 +0100 1108574 http://www.medworm.com/index.php?rid=1093040&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F12%2Fanother-day-another-deferred.html As I mentioned earlier, a major impetus for setting up this blog was finding out that most physicians knew local examples of badly or corruptly run local health care organizations, and felt that their core values were threatened by the actions of these organizations. However, the doctors all felt they were peculiarly unlucky to practice in such a uniquely sleazy environment. They did not realize that things were likely just as bad in the next town, and thus, that the problems were systemic. When I have taken my Health Care Renewal talk on the road, only a few people in the audiences have ever heard of some of the most vivid examples of bad health care organizational governance, e.g., the collapse of the Allegheny Health Education and Research Foundation (see post here).So it may be easy to... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1093040 Thu, 13 Dec 2007 20:32:00 +0100 1093040 http://www.medworm.com/index.php?rid=1076203&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F12%2Fsome-payback-by-former-managed-care-ceo.html We had posted often (see these posts here, here, and here from 2006 with links backward) about the hugely lavish compensation afforded to the Dr William McGuire, former CEO of UnitedHealth Group, one of the largest US insurers/ managed care organizations, and how this remuneration stood in stark contrast to the stated mission of UnitedHealth Group:UnitedHealth Group is a diversified health and well-being company dedicated to making the health care system work better. The company directs its resources into designing products, providing services and applying technologies that:- Improve access to health and well-being services;- Simplify the health care experience;- Promote quality; and,- Make health care more affordable.Most recently, controversy has swirled over the timing of huge stock opt... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1076203 Fri, 07 Dec 2007 01:21:00 +0100 1076203 http://www.medworm.com/index.php?rid=1051214&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F11%2Fhealth-plans-programs-cancelled-for.html The Hartford Courant reported last week how the state of Connecticut has stopped four managed care organizations/ health care insurers from running its HUSKY state insurance program for poor children.Escalating a long-running battle over the state's Freedom of Information law,the state is yanking the primary management of the HUSKY health insurance program for poor children out of the hands of four insurance companies.The announcement Monday by Gov. M. Jodi Rell marked the latest stage in a battle that has lasted more than two years over whether the private companies could be forced to comply with public FOI disclosure laws.The HMOs have refused to reveal the rates they pay to doctors for various services, saying the information is proprietary. Legislators have also complained that the ins... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1051214 Mon, 26 Nov 2007 16:27:00 +0100 1051214 http://www.medworm.com/index.php?rid=1036874&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F11%2Fhealth-net-statements-inoperative-in.html A little while ago we posted about accusations that Health Net Inc, a for-profit managed care organization, cancelled individual health insurance policies after the policy-holders became ill and filed claims. Now the company is also accused of trying to conceal related information from state regulators.The San Francisco Chronicle reported thatState health regulators fined Health Net Inc. $1 million Thursday for lying to investigators about paying employees bonuses based on the number of contracts they canceled after those policyholders got sick.The penalty was the first levied on a health insurer for withholding information about incentives given to its employees.Health Net, along with other major health insurers, is being investigated for combing through applications of members after they... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1036874 Mon, 19 Nov 2007 20:23:00 +0100 1036874 http://www.medworm.com/index.php?rid=1027082&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F11%2Fphysicians-and-contracts-cautionary.html A conversation yesterday with one of my colleagues reminded me of this issue. So forgive me if I reference some articles that are a few weeks old.The relevant news article by Lisa Girion was in the Los Angeles Times the beginning of November. The issue was that a major California insurer, Blue Cross of California, a subsidiary of Wellpoint Inc, was accused of putting a confidentiality provision into its contracts with physicians and hospitals that prevented them from consulting lawyers for their help in contract negotiation:The state stepped into a bitter battle Thursday between Blue Cross of California and the doctors, hospitals and medical labs that serve about 700,000 people covered by the state's largest health plan.At issue is the contentious financial relationship between medical pro... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1027082 Wed, 14 Nov 2007 15:56:00 +0100 1027082 http://www.medworm.com/index.php?rid=935231&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F10%2Fmanaged-care-promises-vs-medicare.html Many health care insurance and managed care companies have lofty mission statements. For example, UnitedHealth Group promises to:- Improve access to health and well-being services;- Simplify the health care experience;- Promote quality; and,- Make health care more affordable.Similarly, Wellpoint promises to:- Bring affordable quality health care and coverage to medically underserved communities- Educate people to take an active role in their own health- Work with our health care partners to improve quality of care- Help shape public policy that makes health care more affordable and more accessibleAnd Humana promises that itmakes health benefits affordable, easy to administer and use, and instills confidence in both employees and employers.In contrast, Robert Pear, writing in the New York T... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=935231 Mon, 08 Oct 2007 20:41:00 +0100 935231 http://www.medworm.com/index.php?rid=805884&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F08%2Fwill-this-house-really-be-home.html A joint press release from several US physician organizations, including the American College of Physicians (ACP), the American Academy of Family Physicians (AAFP), and the American Academy of Pediatrics (AAP), and the UnitedHealth Group announced a pilot project to implement the "advanced medical home" concept.Briefly, according to principles asserted by the AAFP, AAP, ACP, and American Osteopathic Association (AOA), the advanced medical home would have four key characteristics: 1) it would be centered on ongoing relationships among patients and their personal physicians; 2) the personal physician would be the leader of a team that takes responsibility for patient care; 3) the personal physician would take responsibility for the patient as a whole person; and 4) the medical home would pro... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=805884 Fri, 17 Aug 2007 14:11:00 +0100 805884 http://www.medworm.com/index.php?rid=740426&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F07%2Fanother-species-of-conflicts-of.html On the Wall Street Journal Health Blog, this post notes that Jack Lord, who is a Senior Vice President at Humana, just resigned from the board of NeuroMetrix, a small medical device manufacturer. The post focused on whether the resignation has to do with NeuroMetrix's current legal problems. I wondered (and asked in a comment) whether Lord's position on both boards was yet another species of board-level conflicts of interest. After all, Humana is a managed care organization/ health care insurer which promises an approach which "makes health benefits affordable, easy to administer and use, and instills confidence in both employees and employers." Presumably, one component of making health care more affordable would be negotiating fair prices with providers and suppliers, including medical d... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=740426 Tue, 17 Jul 2007 20:23:00 +0100 740426 http://www.medworm.com/index.php?rid=728416&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F07%2Fblogscan-when-fighting-wooden-headed.html On the Running a Hospital blog, Paul Levy describes how Virginia Mason Medical Center in Seattle tried to increase the quality and efficiency of its services for specific medical conditions, with prompting from health insurer Aetna Inc. We had posted about these efforts, which seemed to be one antidote to the sort of wooden-headed health reimbursement policies leading to higher costs and lower quality that we have decried. The problem with Aetna's and Virginia Mason's well-intentioned efforts were that they have hurt the Medical Center's bottom line, which is mainly a factor of the traditional, wooden-headed reimbursement policies of other commercial insurers, and of Medicare and Medicaid. It seems no good deed goes unpunished.... (Source: Health Care Renewal) Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=728416 Wed, 11 Jul 2007 19:29:00 +0100 728416 http://www.medworm.com/index.php?rid=726228&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F07%2Fpaying-for-access-to-academic-and.html The New York Times just reported on a conference for "university, school, and hospital officials" with an interesting feature. Potential vendors to these institutions were charged very pricy registration fees that guaranteed them one-on-one access to particular officials. In the words of the Times reporter Alan Finder,The setting for a conference of university, school and hospital officials could not have been more luxurious: a resort in the high desert north of Albuquerque, with a championship golf course, swimming pools, a spa and views of distant mountain peaks.And for companies wanting to do business with the 200 or so officials attending the gathering, the Sustainable Operations Summit, there was an added benefit.For $18,500, a vendor was guaranteed 15 one-on-one sales meetings with o... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=726228 Tue, 10 Jul 2007 20:34:00 +0100 726228 http://www.medworm.com/index.php?rid=714693&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F07%2Fmore-than-half-of-wellpoints-policy.html We have posted previously about how US managed care organizations and health insurance companies like to publicize their warm and fuzzy qualities, while their track records often suggest that they place profits ahead of concerns about patients' welfare. For example, see this post on the continuing investigation of how Blue Cross in California, a subsidiary of for-profit WellPoint Inc., revoked individuals' health care policies after they made their first major claims.Now Lisa Girion, writing in the Los Angeles Times, has reported:BC Life & Health revoked 1,880 individual health insurance policies in California in 2004 and 2005, and a state agency that examined a sampling says it found that more than half the cases it reviewed were improperly handled.The Department of Insurance said it stud... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=714693 Wed, 04 Jul 2007 19:32:00 +0100 714693 http://www.medworm.com/index.php?rid=650723&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F06%2Fwellpoint-cfo-fired-but-why.html We have been writing a lot about pharmaceutical manufacturers lately, so it's time to break up the monotony. Similar cryptic stories just appeared about the sudden departure of the Chief Financial Officer (CFO) of one of the US largest for-profit health care insurers/ managed care organizations. For example, from Bloomberg.com,WellPoint Inc. fired Vice Chairman David C. Colby, named the best health-insurance chief financial officer for each of the past four years by Institutional Investor magazine, over violations of company rules.The unspecified breaches of a conduct code were 'of a non-business nature' and didn't involve illegality, WellPoint, the second-biggest U.S. provider of medical coverage, said today in a statement.Colby, who was also an executive vice president of WellPoint, didn... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=650723 Fri, 01 Jun 2007 17:53:00 +0100 650723 http://www.medworm.com/index.php?rid=499175&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F03%2Fwellpoint-fined-1-million-for-canceling.html The Los Angeles Times just reported,Blue Cross of California 'routinely' violated state law when it canceled individual health insurance coverage after policyholders got pregnant or sick, making no attempt to determine whether they did anything to merit such "harsh" treatment, according to a state investigation of practices that appear to be industrywide.As a result of its unprecedented investigation, the Department of Managed Health Care on Thursday said that it had fined Blue Cross $1 million — an amount immediately criticized by canceled policyholders and consumer advocates as too small to matter to an insurer whose parent company, WellPoint Inc., earned $3.1 billion in profit last year on revenue of $57 billion.Indianapolis-based WellPoint disputed the findings, saying it acted legal... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=499175 Sat, 24 Mar 2007 14:46:00 +0100 499175 http://www.medworm.com/index.php?rid=484899&cid=t_454997_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F03%2Funitedhealth-declares-health-care.html Those who read the print version of the Wall Street Journal opened it yesterday (19 March) to find a full page advertisement from UnitedHealth Group, with a dramatic red background. The advertisement is not on the web, as far as I can tell, but its text is below:The health care system isn't healthy. There's no denying it. A system that was designed to make you feel better often just makes things worse. Costs are out of control, access is inconsistent, quality is too variable and the entire process has become unwieldy.Every day, more Americans are added to the rolls of the uninsured. This is an epidemic and it's time we found a cure.At UnitedHealthcare, we are committed to improving the health care system. We aim to take what's wrong and make it right.> Simplifying everything and eliminatin... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=484899 Tue, 20 Mar 2007 18:40:00 +0100 484899