MANAGED CARE January 2005. ©MediMedia USA
More on the pay-for-performance push. MedVantage, a consulting company, says that more such programs (42 percent) are now aimed at specialty care. But physicians are wary. "There are a lot of established markers for quality care in our specialty, but often even in those, there is disagreement," Ronald Vender, MD, a partner at the Gastroenterology Center of Connecticut, tells the Wall Street Journal.... The nation's HMOs operated on a slim profit margin in the first three months of 2004, according to Weiss Ratings. This, despite the fact that they reported $3 billion in profit, representing a $742 million increase over the $2.3 billion the companies earned for the same period in 2003. "Although the industry has enjoyed an increase in revenues by raising premiums, insurers have also had to deal with the rising cost of medical care as a result of more open networks, an aging population, expensive medical advances, and an inefficient health care system," says Melissa Gannon, Weiss's vice president.... Health coverage is not a factor in determining the level of care children ages four months to 35 months receive in the U.S., according to a study in December issue of Pediatrics. Neither is race, ethnicity, or income. Then why, according to the study, is one-third of that population not getting the preventive care it needs? "I think, frankly, [providers] are not doing the kind of job they should be doing," Barry Zuckerman, MD, chief of pediatrics at Boston Medical Center, tells the Boston Herald.... CMS has selected the 26 regions of the country where Medicare Advantage will offer PPOs. It also unveiled last month the 34 regions where private drug coverage will be offered to beneficiaries. The reaction of health plan officials, who wanted more regions, was mixed. Karen Ignagni, president and CEO of America's Health Insurance Plans, appreciated that CMS "really worked hard" to come up with the plan. Alissa Fox, policy director for Blue Cross and Blue Shield Association, said that "This makes it more difficult for the Blues plans."