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 'group health'. Sat, 03 Sep 2011 02:26:49 +0100 http://www.medworm.com/index.php?rid=5096205&cid=t_358536_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwill-patients-accept-the-patient-portal-as-the-next-big-thing%2F2011.08.04 There seems to be an inverse relationship between the amount of spin one hears about “the next big thing”…and reality.    First it was EMRs and virtual e-visits, then social media, and now patient portals seem poised to be next big thing.  The drumbeat of vendors and pundits is unmistakable….physicians that don’t adapt will be toast.   It can all sound pretty convincing until you ask to see the evidence.  What do patients think? Take the physician patient portal.   If you read between the lines, patient portals are frequently being positioned as the new “front door” to physician practices.   By signing on to a secure website patients will have real time access to the electronic health record and will be able to communicate with their physicians by e-mail.   Addit... Better Health blogs http://www.medworm.com/rss/comments.php?id=5096205 Thu, 04 Aug 2011 16:00:59 +0100 5096205 http://www.medworm.com/index.php?rid=5036231&cid=t_358536_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fstudy-investigates-relief-for-chronic-back-pain%2F2011.07.17 This study confirmed what I have known for a long time.  They looked at relaxation massage and structural massage, which focuses on correcting soft-tissue abnormalities.  At 10 weeks they found (more…) *This blog post was originally published at EverythingHealth* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5036231 Sun, 17 Jul 2011 12:00:00 +0100 5036231 http://www.medworm.com/index.php?rid=4794819&cid=t_358536_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2011%2F05%2F06%2Fnursing-times-2011-vol-107-no-17%2F Fade Fave: Pelvic floor health: information for teenagers Fade Skinny: Young women were involved in developing a leaflet about pelvic floor awareness with the aim of maintaining and improving pelvic floor health. Contact the Library for a copy of this article Filed under: Ooops Missed Category! Tagged: Focus Group, Health Promotion, Leaflet, Pelvic Floor Muscle Exercise, Teenagers (Source: Fade Library) Fade Library blogs http://www.medworm.com/rss/comments.php?id=4794819 Fri, 06 May 2011 11:08:18 +0100 4794819 http://www.medworm.com/index.php?rid=4676899&cid=t_358536_113_f&fid=34625&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FNeilVerselsHealthcareItBlog%2F%7E3%2FEcS5gp-MhXQ%2F Geisinger Health System, Group Health Cooperative, Intermountain Healthcare, Kaiser Permanente and the Mayo Clinic will join together to promote sharing of electronic health data as part of a new organization called the Care Connectivity Consortium. The formal launch is set for 9 a.m. EDT Wednesday at the National Press Club in Washington, and the event will be webcast here. According to a media advisory, the Care Connectivity Consortium is “a historic interoperability collaboration among five of the nation’s leading health systems to securely share electronic health information and best practices.” Executives from the organizations will be on hand to “will discuss the goals of the consortium, how sharing electronic health data supports high quality, patient-centered ca... Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=4676899 Mon, 04 Apr 2011 17:06:21 +0100 4676899 http://www.medworm.com/index.php?rid=4664342&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002068.html In a brief news announcement late yesterday, giant healthplan Wellpoint announced it is going to enter the workers comp insurance market. Initially targeting California, the plan is to begin a gradual rollout into other states where they have significant group... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4664342 Thu, 31 Mar 2011 23:00:00 +0100 4664342 http://www.medworm.com/index.php?rid=4450382&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F002025.html Coventry's 2010 earnings report is out, and the news was generally pretty good. Revenues are down considerably, but that's due to the company's decision to exit Medicare private Fee for Service; operating earnings are up for the year (from 3.6%... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4450382 Tue, 08 Feb 2011 00:00:00 +0100 4450382 http://www.medworm.com/index.php?rid=4275422&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001993.html The second edition of the 'Benefits Package' is up at Evan Falchuk's SeeFirst blog. It's a quick synopsis of some pretty good thinking on what's up and why.... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4275422 Tue, 21 Dec 2010 00:00:00 +0100 4275422 http://www.medworm.com/index.php?rid=4214309&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001971.html We've all had a few days to digest the recently announced Humana - Concentra deal, and perhaps think thru what this means for Humana, why they did the deal, and if this gives any insight into what other health plans... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4214309 Mon, 29 Nov 2010 00:00:00 +0100 4214309 http://www.medworm.com/index.php?rid=4190312&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001968.html In an announcement a few minutes ago, healthplan company Humana announced it intends to buy occ clinic firm Concentra for $790 million. Currently Concentra has about 300 facilities and 240 on-site clinics and revenues of $800 million. The deal does... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4190312 Mon, 22 Nov 2010 00:00:00 +0100 4190312 http://www.medworm.com/index.php?rid=4152010&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001955.html There was a lot of good news for Coventry Health last quarter, much due to what CEO Allen Wise called "unusually low medical trend". That said, 2011's numbers are not likely to be as robust as this year, and Wise... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=4152010 Tue, 09 Nov 2010 00:00:00 +0100 4152010 http://www.medworm.com/index.php?rid=3914994&cid=t_358536_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2FpKo4bfVXKQ0%2F By Glenna Crooks. I still remember the first patient advocate I ever met – Henrietta Aladjem. She outlived predictions of imminent death from Lupus and despite her condition helped others, providing information, inspiration, advocacy and hope everywhere she went. Gracefully. Persistently. Since then I’ve met more than 10,000 advocates – some of them children – in 26 countries. In their work they help millions of patients and families address hundreds of diseases and the consequences patients face to get insurance, education, housing, employment and civil rights. In many cases, they or a loved one were in dire need of help they did not receive, so they vowed to help others. It was  a way to reclaim  power, to work through grief or to constructively use anger. It’s impos... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=3914994 Mon, 30 Aug 2010 10:14:43 +0100 3914994 http://www.medworm.com/index.php?rid=3862099&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001884.html Mark Farrah and Associates' latest report indicates health plans enjoyed a nice bump in enrollment in Q1 2010 from the previous quarter, with the entire increase coming from ASO (large, administrative-services only plans that are sold to larger employers) business.... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3862099 Wed, 11 Aug 2010 23:00:00 +0100 3862099 http://www.medworm.com/index.php?rid=3813077&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001875.html Data from several sources, including Farrah and Associates (got to love a company that is located in Maine) indicates group insurers were able to reduce medical trend to 4.9% last year. That's the best result, in, well, further back than... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3813077 Sun, 01 Aug 2010 23:00:00 +0100 3813077 http://www.medworm.com/index.php?rid=3805919&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001877.html Coventry earnings call this morning was notable in at least two ways - more discussion about underlying cost drivers, utilization trends and management thereof, and the growing importance of low cost delivery systems from management. And more evidence that (most)... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3805919 Thu, 29 Jul 2010 23:00:00 +0100 3805919 http://www.medworm.com/index.php?rid=3772344&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001868.html Some physicians and physician groups are quite upset about insurers' recent moves to offer employer customers tight, small networks of providers based on quality and cost criteria. In an effort to block these new plans, the AMA and other groups... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3772344 Mon, 19 Jul 2010 23:00:00 +0100 3772344 http://www.medworm.com/index.php?rid=3706677&cid=t_358536_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fis-doctor-patient-communication-better-in-medical-homes%2F2010.06.28 Probably not yet. I think everyone would agree that Group Health of Seattle probably has a pretty good “take” on issues dealing with primary care redesign and the patient-centered medical home (PCMH). That’s why I surprised by a recent comment on a Group Health blog from by Matt Handley, M.D., in response to an earlier post here about patient question-asking. Dr. Handley is an Associate Medical Director for Quality and Informatics at Group Health. Dr. Handley writes: “While doctors often take pride in how open they are to patient questions, our self assessment doesn’t match up very well with empirical evidence. A recent post on Mind the Gap summarizes a small study that is relatively terrifying to me –- the take home is that doctors spend very little time explaining their reco... Better Health blogs http://www.medworm.com/rss/comments.php?id=3706677 Mon, 28 Jun 2010 14:00:45 +0100 3706677 http://www.medworm.com/index.php?rid=3644763&cid=t_358536_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-medical-home-in-ontario-the-poor-left-behind-again%2F2010.06.09 In a recent blog posting, I described Group Health’s medical home for 8,000 patients. It proved to be a boon for primary care physicians, who were able to reduce the size of their patient panels, see fewer patients per day, refer more patients to specialists, and maintain or increase their incomes. Patients liked it, too. And Group Health was happy because expenditures per patient were 2 percent lower. But poor patients had trouble getting through the front door of the medical home, so based on demographic differences alone, expenditures should have been lower by 10 percent or more. Nonetheless, they declared victory. Now news filters south from Ontario’s eight-year experiment with medical homes for 8,000,000 patients, and the news is similar. Participation is skewed to healthier an... Better Health blogs http://www.medworm.com/rss/comments.php?id=3644763 Wed, 09 Jun 2010 14:00:52 +0100 3644763 http://www.medworm.com/index.php?rid=3549308&cid=t_358536_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoes-group-health%25e2%2580%2599s-medical-home-leave-the-poor-behind%2F2010.05.10 Group Health has published two papers recently, one in Health Affairs and the other in JAMA, both extolling the virtues of its Medical Home. These follow their brief report last fall in the NEJM and the lengthy description of their model in the American Journal of Managed Care. Their model has been promoted by the Commonwealth Fund, and it is cited in the currrent issue of Lancet. The big news is that costs were a full 2% lower than conventional care, hardly a great success –- it wasn’t even statistically significant. But was even this small difference due to the Medical Home, or was it because the Medical Home patients were less likely to consume care? (more…) *This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*... Better Health blogs http://www.medworm.com/rss/comments.php?id=3549308 Mon, 10 May 2010 12:00:57 +0100 3549308 http://www.medworm.com/index.php?rid=3519568&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001810.html Coventry released its Q1 2010 financials today, and looking at the numbers one would have to be a naysayer to find fault. The company is successfully exiting the Medicare Private Fee for Service business, growing its Medicare, Medicaid, and Part... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3519568 Thu, 29 Apr 2010 23:00:00 +0100 3519568 http://www.medworm.com/index.php?rid=3275955&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001745.html Pretty well. With the demise of health reform and the company's continued focus on core businesses at the expense of ancillary or unrelated operations, things are looking up for the mid-tier managed care company. Last week's Q4 2009 earnings call... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3275955 Tue, 16 Feb 2010 00:00:00 +0100 3275955 http://www.medworm.com/index.php?rid=3267046&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001714.html Probably a lot. Perhaps most. And certainly a big chunk of the bucks your insurer/TPA is paying. Unlike surgery, imaging, drugs, and other types of medical treatment, PT has long been a bit of a black art. The clinical guidelines... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3267046 Fri, 12 Feb 2010 00:00:00 +0100 3267046 http://www.medworm.com/index.php?rid=3223323&cid=t_358536_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F01%2F29%2Fobama-rules-for-mental-health-parity-issued%2F Remember the federal legislation passed in late 2008 that requires insurance companies to bring their mental health coverage in parity with their health coverage? Well, technically that law took effect 29 days ago, but the Obama administration got around today to publishing the rules that put the law into effect. The U.S. Departments of Health and Human Services, Labor and the Treasury today jointly issued new rules providing parity for consumers enrolled in group health plans who need treatment for mental health or substance use disorders. The rules are a part of the governmental process that implements the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). First, to be clear, what the new federal law does not cover: Employers with less than ... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3223323 Fri, 29 Jan 2010 17:54:25 +0100 3223323 http://www.medworm.com/index.php?rid=3185621&cid=t_358536_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2F30WnsgICjfI%2F As the debate continues over access to medicines in poor countries and the World Health Organization’s Expert Working Group readies a May report on R&D financing and intellectual property, Aidan Hollis, an economics professor at the University of Calgary, is pushing his Health Impact Fund. The plan leaves patent exclusivity intact, which has provoked some skepticism (see here). We spoke with him briefly and learned this… Pharmalot: What is the Health Impact Fund? Hollis: The fund is a proposal for a new way to pay for innovative drugs that would essentially have a large pool of money to be paid out every year. It’s a reward fund. And companies could get a share of this reward fund by registering their drug with the HIF and selling product at cost of production…... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=3185621 Tue, 19 Jan 2010 13:05:16 +0100 3185621 http://www.medworm.com/index.php?rid=3182269&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001724.html I've been working with a mid-sized self-insured employer on their health benefits plan; they got hit hard with costs from diabetes last year and the (relatively thin) data available suggests it's going to get worse in the near future; there... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3182269 Mon, 18 Jan 2010 00:00:00 +0100 3182269 http://www.medworm.com/index.php?rid=3142693&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001711.html CIGNA has a new CEO, David Cordani, who is planning on growing the company internationally. Which may, or may not, have implications for CIGNA's IntraCorp subsidiary. IntraCorp, the managed care subsidiary of insurance company CIGNA, was perhaps one of the... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=3142693 Tue, 05 Jan 2010 00:00:00 +0100 3142693 http://www.medworm.com/index.php?rid=2984907&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001679.html There are some things I just don't get. Bungee jumping, the Ruta de los Conquistadores, body piercing are near the top of the list, just under equity investors' reactions to health reform. And it doesn't look like my health investor... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=2984907 Thu, 12 Nov 2009 00:00:00 +0100 2984907 http://www.medworm.com/index.php?rid=2793281&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001626.html Coventry CFP Shawn Guertin confirmed the company's commitment to workers comp in this morning's Morgan Stanley Global Healthcare Conference, noting comp is a : "[somewhat] different piece [compared to their medicare and commercial business] that has performed very well this... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=2793281 Sun, 13 Sep 2009 23:00:00 +0100 2793281 http://www.medworm.com/index.php?rid=2688777&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001600.html PPO company Viant (owner of Beech Street and PPONext) will be acquired by larger PPO company MultiPlan. The announcement came last week; here's the lead from the internal memo to employees: "After much thought and deliberation by our Board of... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=2688777 Sun, 09 Aug 2009 23:00:00 +0100 2688777 http://www.medworm.com/index.php?rid=2685279&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001600.html PPO company Viant (owner of Beech Street and PPONext) will be acquired by larger PPO company MultiPlan. The announcement came last week; here's the lead from the internal memo to employees: "After much thought and deliberation by our Board of... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=2685279 Sun, 09 Aug 2009 23:00:00 +0100 2685279 http://www.medworm.com/index.php?rid=2678733&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001597.html The stock prices of health insurers wax and wane with the likelihood of health reform becoming reality - although in inverse. The announcement last month that the outlook for most of the major health insurers had been downgraded to (or... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=2678733 Thu, 06 Aug 2009 23:00:00 +0100 2678733 http://www.medworm.com/index.php?rid=2598348&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001567.html Shawn Guertin, Coventry's CFO, spoke at the Wachovia investor day conference late last month, and here, so you don't have to listen to the entire webcast, are the highlights. But if you do want to, it is still available here... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=2598348 Sun, 12 Jul 2009 23:00:00 +0100 2598348 http://www.medworm.com/index.php?rid=2442083&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001533.html The fine folks at FierceHealthcare have compiled a list of the top ten health plan CEOs ranked by compensation. The links include details on performance, prior year compensation, and a bit of editorial. Aetna Ron Williams $24,300,112 CIGNA Ed Hanway... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=2442083 Thu, 21 May 2009 04:00:00 +0100 2442083 http://www.medworm.com/index.php?rid=2398872&cid=t_358536_113_f&fid=38236&url=http%3A%2F%2Fwww.healthcareitnews.com%2Fblog%2Fhealth-it-stimulus-and-fqhcs-dont-forget-about-us There is a critical element in the American Recovery and Reinvestment Act (ARRA) that targets funds for Federally-Qualified Community Health Centers (FQHCs).  (Source: Healthcare IT News Blog) Healthcare IT News Blog blogs http://www.medworm.com/rss/comments.php?id=2398872 Fri, 08 May 2009 15:48:31 +0100 2398872 http://www.medworm.com/index.php?rid=2376414&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001504.html This is a big day for mid-tier healthplan Coventry. After a year of turmoil and ups and (mostly) downs, CVTY has been under the leadership of returning CEO Allen Wise for a full quarter. Today Coventry announced Q1 results, which... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=2376414 Tue, 28 Apr 2009 04:00:00 +0100 2376414 http://www.medworm.com/index.php?rid=2349023&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001487.html PPOs, or Preferred Provider Organizations, have been around for a couple dozen years. They are networks of credentialed (with varying degrees of rigor) doctors, hospitals, and ancillary providers that have agreed to provide lower rates for 'members' in return for... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=2349023 Tue, 14 Apr 2009 04:00:00 +0100 2349023 http://www.medworm.com/index.php?rid=2291700&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001467.html There is a growing movement on the part of providers that is turning the tables on health plans. Providers have long objected to profiling, ranking, and rating as done by health plans, complaining (with and without justification) that the systems/algorithms... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=2291700 Thu, 26 Mar 2009 04:00:00 +0100 2291700 http://www.medworm.com/index.php?rid=2291710&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001458.html Small employers are increasingly dropping health insurance. Premiums are prohibitively expensive and dire economic times are forcing owners to cut costs. In an effort to control costs, some are resorting to what can only be characterized as fraud. I recently... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=2291710 Wed, 18 Mar 2009 04:00:00 +0100 2291710 http://www.medworm.com/index.php?rid=2177512&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001423.html Because they allowed workers comp and national accounts to dictate provider contracting strategies, a decision that drove up the core group business' medical loss ratio. Here's how. The beginning of the tough times for Coventry came last spring. Up till... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=2177512 Wed, 11 Feb 2009 05:00:00 +0100 2177512 http://www.medworm.com/index.php?rid=2137568&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001407.html Yesterday's announcement that Coventry had replaced CEO Dale Wolf with former CEO Allen Wise came after an internal review of the company's performance, a review that didn't come out too well. According to Dow Jones, "The move comes after a... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=2137568 Tue, 27 Jan 2009 05:00:00 +0100 2137568 http://www.medworm.com/index.php?rid=2121665&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001402.html It's no secret that Coventry Health had a tough 2008. After several years of continued growth in profits, revenues, and market cap, management was nothing if not self-confident. Perhaps not self-aware, but certainly self-confident. That ended a little less than... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=2121665 Wed, 21 Jan 2009 05:00:00 +0100 2121665 http://www.medworm.com/index.php?rid=2097894&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001396.html This is one tough year to be putting on the swami hat and dusting off the crystal ball. There are so many moving pieces affecting the group health/individual/Medicare/ Medicaid world that it will be hard enough to analyze what happened... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=2097894 Mon, 12 Jan 2009 05:00:00 +0100 2097894 http://www.medworm.com/index.php?rid=1914623&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001335.html The public does not like health insurance companies. And neither does Congress. Health plans are blamed for rising health care costs by far more Americans than point an accusing finger at pharma companies, the government, hospitals or physicians. Fully 41%... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=1914623 Tue, 28 Oct 2008 04:00:00 +0100 1914623 http://www.medworm.com/index.php?rid=1862740&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001324.html Many benefits professionals and risk managers evaluate networks based, at least to some degree, on the thickness of the directory and the depth of the discount. The logic is - hey, the more hospitals in there, and the better the... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=1862740 Thu, 09 Oct 2008 04:00:00 +0100 1862740 http://www.medworm.com/index.php?rid=1825633&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001312.html The short answer is - it got combined with other sorta-kinda related businesses and put under one boss - Dan Fishbein, MD, in the "New Product Businesses" unit. According to an Aetna Communications staffer; "AWCA is part of the New... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=1825633 Wed, 24 Sep 2008 04:00:00 +0100 1825633 http://www.medworm.com/index.php?rid=1788703&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001295.html Could be. For a couple days there have been rumors swirling around Hartford (Aetna's hometown) that the big insurer may be looking at Coventry's books ahead of a possible acquisition. With Coventry's stock still relatively low, and at a P/E... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=1788703 Fri, 12 Sep 2008 04:00:00 +0100 1788703 http://www.medworm.com/index.php?rid=1537922&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001238.html The big question is this: is Coventry's screwup a symptom of a larger issue, or is it specific to Coventry? As of now it looks like the problems are not industry-wide. This leaves one inescapable conclusion - mistakes by management.... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=1537922 Mon, 23 Jun 2008 04:00:00 +0100 1537922 http://www.medworm.com/index.php?rid=1531234&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001237.html Since Coventry's announcement late Wednesday that they were cutting earnings projections almost in half, the financial markets have been hammering health plan stocks. Their pessimism may be overdone. Humana and Aetna have reaffirmed their earnings forecast while Wellpoint, Cigna, and... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=1531234 Fri, 20 Jun 2008 04:00:00 +0100 1531234 http://www.medworm.com/index.php?rid=1531235&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001236.html The notice for the teleconference popped up in my email inbox a mere hour and a half before the telecon was scheduled to begin. That was the first indicator of potential trouble. The second was the opening line from Coventry's... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=1531235 Thu, 19 Jun 2008 04:00:00 +0100 1531235 http://www.medworm.com/index.php?rid=1426343&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001206.html Ingenix has had a tough few months. The latest injury comes in the form of a suit filed by a Connecticut man, seeking class action status based on allegations that the United HealthCare sub engaged in an "alleged conspiracy in... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=1426343 Wed, 07 May 2008 04:00:00 +0100 1426343 http://www.medworm.com/index.php?rid=1396221&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001196.html Friend and colleague Bob Laszewski has shined a very bright light on Wall Street's ignorance about the health insurance business. Bob notes: "We are way past the time the really smart people on Wall Street (that would be all of... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=1396221 Thu, 24 Apr 2008 04:00:00 +0100 1396221 http://www.medworm.com/index.php?rid=1391028&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001185.html Anthem/Wellpoint's ill-fated efforts to reduce medical costs by retroactively cancelling policies for members with mistakes on applications has become the company's open sore. The latest is the filing of a major lawsuit by the City of Los Angeles, accusing the... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=1391028 Tue, 22 Apr 2008 04:00:00 +0100 1391028 http://www.medworm.com/index.php?rid=1347371&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001165.html When a high-flying stock hits the tank, owners get nervous. In some cases (Enron and Bear Stearns come to mind) that is an appropriate reaction. In others, the only reaction is to look with incredulity at the behavior of the... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=1347371 Thu, 03 Apr 2008 04:00:00 +0100 1347371 http://www.medworm.com/index.php?rid=1319344&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001158.html Wellpoint has been slammed (justifiably) for its rescission practices (retroactively canceling insureds' policies when they have the temerity to actually get care) and sued for allegedly inflating earnings expectations (although some of the slamming is, in my view, unjustified). United... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=1319344 Thu, 20 Mar 2008 04:00:00 +0100 1319344 http://www.medworm.com/index.php?rid=1182797&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001108.html As I've noted repeatedly, there is a place for consumerism in health care, but it is by no means a panacea. And many CDH Plans are poorly designed and will likely lead to higher costs down the road - studies... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=1182797 Mon, 28 Jan 2008 05:00:00 +0100 1182797 http://www.medworm.com/index.php?rid=1070449&cid=t_358536_113_f&fid=36670&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2Fmsdn%2Fhealthblog%2F%7E3%2F195199280%2Fmore-evidence-the-healthcare-world-is-flat.aspx I'm writing this on my flight back to Seattle from the Consumer Health World Conference in Washington, D.C.  The conference is actually just getting underway.  My stay was abbreviated due to the fact that I have a mid-week speaking engagement in California followed by a return trip to D.C. at week's end to speak at the World Healthcare Innovation and IT Congress.  My brief stay at Consumer Health World was to facilitate a faculty leadership summit.  I've done this the past three years and always find it interesting.  This year we debated the fate of employer paid health insurance, the rise of medical tourism, and the future of primary care.  While all of the topics generated lively debate, I was perhaps most impressed by the rapid expansion of the overseas hea... HealthBlog blogs http://www.medworm.com/rss/comments.php?id=1070449 Tue, 04 Dec 2007 21:32:10 +0100 1070449 http://www.medworm.com/index.php?rid=1055642&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001067.html Today's a "suit day"; one of those increasingly-frequent days where business demands require something a bit more upscale than the usual. Today's event is the Piper Jaffray Healthcare Investor conference in NYC, where I'm on a panel discussing Consumer-directed health... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=1055642 Wed, 28 Nov 2007 05:00:00 +0100 1055642 http://www.medworm.com/index.php?rid=908562&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001014.html Premium increases are low in part because benefits have been decreased and employee contributions increased. Chris made this point yesterday in a comment on my post about low trend rates. Is that really happening? No, yes and hell yes.... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=908562 Thu, 27 Sep 2007 04:00:00 +0100 908562 http://www.medworm.com/index.php?rid=906054&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F001013.html It looks like employers' health care costs will increase by somewhere in the mid-to-high single digits next year. According to one survey, costs for employer-sponsored health insurance will average over $9300 per worker next year. That's just 7% more than... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=906054 Wed, 26 Sep 2007 04:00:00 +0100 906054 http://www.medworm.com/index.php?rid=815155&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F000978.html The bright light of practice evaluation is making more than a few physicians uncomfortable; these docs have decided that it is somehow unfair for insurers to suggest members go to specific physicians. So, like all red-blooded Americans, the docs are... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=815155 Wed, 22 Aug 2007 04:00:00 +0100 815155 http://www.medworm.com/index.php?rid=788174&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F000970.html CMS' hospital reimbursement change is going to create winners and losers; among the biggest winners will be UnitedHealthcare. Among the losers, their competitors.... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=788174 Wed, 08 Aug 2007 04:00:00 +0100 788174 http://www.medworm.com/index.php?rid=774144&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F000966.html Coventry's latest quarter was a good one. The key to financial success in the health plan business is the MLR, or medical loss ratio; Coventry delivered a Q2 MLR of 77.5% resulting from a combination of higher premiums and lower... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=774144 Thu, 02 Aug 2007 04:00:00 +0100 774144 http://www.medworm.com/index.php?rid=571078&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F000864.html The merger and consolidation process continues. Coventry Healthcare is acquiring two small health plans in the midwest and another chunk of the Federal Employee Health Benefit Plan. Coventry is a strong player in the mid to smaller employer market, and... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=571078 Thu, 26 Apr 2007 04:00:00 +0100 571078 http://www.medworm.com/index.php?rid=554429&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F000858.html My post a couple of weeks ago about the RFP process generated a lot of public and even more private comment. It got me thinking about one of the more contentious issues in the vendor-customer relationship - price.... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=554429 Thu, 19 Apr 2007 04:00:00 +0100 554429 http://www.medworm.com/index.php?rid=534088&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F000847.html Insurance companies, employers, and TPAs rely on vendors to process bills, build and operate networks, manage prescriptions and PT, support litigation, and provide expert advice on problematic medical issues. In many instances the vendors are selected thru a competitive bidding... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=534088 Tue, 10 Apr 2007 04:00:00 +0100 534088 http://www.medworm.com/index.php?rid=522823&cid=t_358536_118_f&fid=34852&url=http%3A%2F%2Fwww.joepaduda.com%2Farchives%2F000845.html Bob Laszewski weighs in on the Wellpoint insurance cancellation debacle. As a former health insurance company president, Bob's perspective is unique.... (Source: Managed Care Matters) Managed Care Matters blogs http://www.medworm.com/rss/comments.php?id=522823 Thu, 05 Apr 2007 04:00:00 +0100 522823