Friday, October 6, 2000

CEO testifies to Pilgrim’s progress: Web helps HMO sail into black ink
Harvard Pilgrim lost $20 million in the first eight months of the year, but the HMO is starting to break even and expects to be making money on a monthly basis by the end of the year, its chief said yesterday.
[Boston Herald 2000-10-05]

Pittsburgh-Area Health Insurance Firm Drops Controversial Compensation Plan
Highmark Blue Cross Blue Shield has dropped plans to adopt a controversial new method for compensating certain medical specialists.
Pittsburgh Post-Gazette via CNNfn 2000-10-05]

Aetna U.S. Healthcare(R) to Launch New Open Access Health Plans With Aetna Navigator(TM) Web Tool
Aetna U.S. Healthcare today announced Aetna Open Access(TM), an array of health plans designed to give consumers choices about how they access their health care services, accompanied by Aetna Navigator, a comprehensive online resource to help consumers make health care choices. Aetna Open Access brings additional choice and flexibility to consumers at an affordable price, while Aetna Navigator provides comprehensive and credible online health information and resources.
[Aetna news release 2000-10-05]

Forcing consumers to share the pain
. . . Even so, workers are not contributing any more out-of-pocket this year than they did last year, and the share of the costs that single people pay for their health care has actually declined — from 21 percent to 14 percent — since 1996, according to the Kaiser Family Foundation. Families are contributing the same as they did four years ago. Workers have made out even better when it comes to the cost of medications. In 1990, they paid for 48 percent of their drug costs, according to Kaiser. By 1998, their share had shrunk to 27 percent.
[Boston Globe 2000-10-05]

Health Plan Performance as Measured by Health Plan Reporting Tool Found to Vary Based on by Enrollee Ethnicity, Education
Performance on the standardized measures used by the nation’s health insurers when computing their scores through the Health Plan Employer Data Set (HEDIS) — the reporting tool that monitors how well health plans perform essential medical services — is influenced by factors such as enrollee schooling, income and ethnic or racial background, according to a new study published in the October issue of the journal, Medical Care.
Scroll down for full text of news release
[PR Newswire 2000-10-05]

Highmark withdraws plan
Highmark Blue Cross Blue Shield has dropped plans to adopt a controversial new method for compensating certain medical specialists.
[Pittsburgh Post-Gazette 2000-10-05]

Doctors sought for quick-pay system test
Empire Blue Cross and Blue Shield in New York is planning to recruit 40 doctors to test a product that promises to make getting paid faster and simpler for physicians. Empire is among investors that have put a collective $42 million into Cranbury, N.J.-based The company is guaranteeing that physicians associated with insurers who use its system will get paid in full 48 hours after a patient’s visit. The 40-doctor test is scheduled to begin by January 2001.
[AM News 2000-10-09]

Thursday, October 5, 2000

Rare HMO Merger to Dominate NY Market
Two of the biggest health insurers in central New York have agreed to merge in an attempt to compete with the state’s biggest insurer, Empire BlueCross BlueShield. Excellus Inc., a Rochester-based company that operates Blue Cross and Blue Shield plans in Rochester, Syracuse and Utica, will join forces with Univera Healthcare, an insurer that serves the Buffalo and Baldwinville region, to create a non-profit company with more than 2 million members and annual revenues of $3.6 billion.
[Medical Industry Today 2000-10-05]

Minnesota Sues Blues Plan for Denying Care to Kids
NEW YORK (Reuters Health) – Minnesota’s attorney general on Tuesday filed suit against Blue Cross and Blue Shield of Minnesota for allegedly denying medically necessary treatment for children and young adults suffering from mental illness, eating disorders and chemical dependency.
[Reuters Health via Fox News 2000-10-04]

Drug Reimportation Battle Rages on
Even as House and Senate negotiators tried to work out a compromise on a bill that would make it easier for pharmacists and wholesalers to import US-made drugs from other countries, the head of the Food and Drug Administration was warning a House subcommittee that the agency is already having difficulty coping with counterfeit drugs from abroad.
[Reuters Health via Medscape 2000-10-04 (Medscape reg.)]

Lawmakers: Final Deal on Drug Reimports
WASHINGTON (Reuters) – Congressional Republican leaders said on Wednesday they had reached a final agreement to allow U.S.-made prescription drugs to be reimported from other countries where they are often sold far more cheaply.
[Reuters via Yahoo 2000-10-04]

Dying patients give researchers new insights on care of terminally ill
Despite the progress made by the hospice and palliative care movement in the care of the terminally ill and helping patients achieve a “good death,” a tragic gap exists between the care that dying people want and the care they receive. . . . Personal acceptance [of death] was higher among patients whose principal clinician was a nurse as opposed to a physician. Women and minorities were more likely to report good patient-clinician relationships. Female patients and younger patients also reported more psychological distress.
[Eurekalert 2000-10-04]

Measuring, Meeting Return on Investment A Challenge for Health Plan Web Sites
Nearly all health plans agree they should have an Internet presence. But when asked to bring hard numbers into the board room, managers find it difficult to quantify the return on investment a plan’s Web site should bring.
[Managed Care Week 2000-10-02]

Harvard Pilgrim sees decline in members
Despite emerging from state receivership four months ago, Harvard Pilgrim Health Care expects that membership will slip by at least another 40,000 this fall as Massachusetts workers choose among various health plans.
[Boston Globe 2000-10-05]

Drug Industry Has Ties to Groups With Many Different Voices
Elizabeth Helms arrived on Capitol Hill on a warm Tuesday afternoon in July with a simple message for Congress: Drug stores, not drug makers, are to blame for the high cost of prescription medicines.
[NY Times 2000-10-05]

New York doctors push health plan to list fee schedule
In a move physicians hope will lead to the routine disclosures of fee schedules at health plans, New York state health regulators have requested the payment schedule of a 200,000-member physician-managed HMO.
[AM News 2000-10-09]

Wednesday, October 4, 2000

Study: Medicare Treatment Mixed
Treatment of Medicare patients varies widely by state when it comes to heart failure, stroke, breast cancer and other life-threatening illnesses, according to a new federal study. Medicare patients in the Northeast and sparsely populated states were most likely to receive widely accepted treatments for such conditions. However, those in the Southeast and more populated states were least likely to get the same treatments, according to the state-by-state comparison in Wednesday’s Journal of the American Medical Association
Direct link to full text of JAMA article
[AP 2000-10-03]

Doctor discovers capitation being lost in costly HMO limbo
When a California pediatrician realized that HMOs swallow capitation for patients who don’t have a primary care physician, he drafted legislation to fight the problem.
[AM News 2000-10-09]

40% of New England HMOs Would Have Failed New RBC Solvency Test
A recent assessment of New England HMOs found that 40% of those reporting risk-based capital data at year-end 1999 would have failed to meet new solvency standards.
[Business Wire 2000-10-03]

Aetna, physicians group agree to deal — The five-year extension will pay doctors more and not impose financial risks on them.
Aetna U.S. Healthcare and Medical Select Management, two major players in local health care, have agreed to a five-year contract extension that will pay physicians higher reimbursements without the risk of rising pharmacy and hospital costs.
[Fort Worth Star-Telegram 2000-09-30]

Humana restructures in South Florida, drops physicians
In an attempt to cut costs, the insurer deselected about 15% of its doctors in one market.
[AM News 2000-10-09]

Group to end pact with Aetna U.S. Healthcare
A group of 170 physicians in the Allentown and Bethlehem area have notified Blue Bell-based Aetna U.S. Healthcare that they plan to terminate their contracts with the managed-care company as of Dec. 31.
[Philadelphia Business Journal 2000-10-02 (reg.)]

Nursing Home ‘Drug Destruction Days’ Waste Drugs, Dollars
In Northport, Ala., it’s drug destruction day at Forest Manor nursing home, and prescription medicine retailing for $4,000 is laid out on tables, ready for final dispensing down a commode or sink.
[AP via WebMD 2000-10-3]

S.F. doctors’ group rolls itself into the morgue
The 500-doctor San Francisco Individual Practice Association will cease operations on Oct. 31, a victim of the failure of an affiliated organization and the loss of 40 percent of its patients.
[San Francisco Business 2000-10-02 ( reg. req.)]

Medicare HMOs raising the cost of drug coverage
Retirees with Medicare HMO coverage in the Philadelphia area are about to face another round of premium increases and a decline in drug coverage. In the next few weeks, Independence Blue Cross and Aetna U.S. Healthcare, which cover more than 90 percent of Southeastern Pennsylvania residents enrolled in Medicare HMOs, will begin to notify subscribers of the changes that will take effect in January.
[Philadelphia Inquirer 2000-10-04]

Coverage Can Be Tailored to Suit Workers, Employers
Consumer-choice health purchasing groups split costs between owners and employees, let them create plans that meet their needs.
[LA TImes 2000-10-04]

Accountant Had Doubts About HMO
In a May letter to the state insurance commissioner, Harvard Pilgrim Health Care Inc.’s independent accountant, PricewaterhouseCoopers, said it has serious concerns about the company’s ability to survive.
[Wall Street Journal 2000-10-04 (sub.)]

Doctors Plan Legal Attack On HMOs
The Texas Medical Association has vowed to be more aggressive about suing health plans on behalf of doctors.
[Wall Street Journal 2000-10-04 (sub.)]

Tuesday, October 3, 2000


Mergers, Acquisitions Afoot In Disease Management Industry
Within a few years, there may be only 30 DM companies left, says one expert. HMO customers want vendors to handle more than one condition.

Groups pull plug on standards unit
What started out as the hub of efforts to simplify healthcare’s performance measurement standards ended last week as a millstone around the necks of the two accrediting bodies and one provider group that founded the council two years ago. The three founders–the Joint Commission on Accreditation of Healthcare Organizations, the National Committee for Quality Assurance and the American Medical Association–said last week that they will “phase out” their joint Performance Measurement Coordinating Council because they can do a better job without it.
[Modern Healthcare 2000-10-02]

Drop in uninsured, drop in HMO ranks
Last week, two trends that conventional wisdom thought would go on forever–more Americans going without health insurance and more enrolled in HMOs–reversed course.
[Modern Healthcare 2000-10-02]

Insurers Are Likely to Cover Recently Approved Abortion Pill
Unlike some other controversial new medicines including Viagra and costly infertility treatments for which insurers resisted initial coverage, it appears as if most major insurers will consider so-called medical abortions a fairly routine procedure for coverage.
[Wall Street Journal 2000-10-02 (sub.)

PPO Power: ‘Preferred’ Is Definitely the Word
. . . PPOs are now eroding HMOs’ market share at a dizzying rate. But costs of all types of health plans are on the rise again. And many industry experts are wondering how long the preference for PPOs — a mechanism by which physicians and other providers contract to offer medical services to an insurer’s or health benefit plan’s enrollees, on a fee-discount basis — will last.
[WebMD 2000-10-03]

Defined contribution health care plan crafted
MINNEAPOLIS—Aon Corp. and Ridgeview Medical Center, an acute-care hospital and clinic system in Minnesota, this fall will become the first employers to offer Definity Health Corp.’s new defined contribution health plan to their employees.
[Business Insurance 2000-10-03]

Teaching hospitals provide better care
A study bolsters the perception that academic centers offer higher quality care. Whether that will influence plans’ contracting decisions remains to be seen.
[AM News 2000-10-03]

Malpractice claim preempted by ERISA
The allegations in this medical malpractice case filed last spring are straightforward. Sindi Green and her husband Richard Green sued her husband’s doctor, Douglas Travis, MD, and his insurer Trustmark Insurance Corp. for negligently treating skin cancer.
[AM News 2000-10-09]

Medicare Drug Benefits: A Case of Conflicting Claims
For weeks, Republicans and Democrats have been bombarding each other–and voters–with charges and countercharges about their rival plans to provide prescription drugs for Medicare recipients.
[Washington Post 2000-10-03]

Health care costs in state still 30% over US average
espite a decade of managed health care and hospital closings, Massachusetts’ medical costs are still 30 percent above the national average, the same as they were 10 years ago, Boston University researchers concluded in a report released yesterday.
[Boston Globe 2000-10-03]

Drug companies pushing product gives docs a pain
Most doctors see them as a major pain in the neck – a phenomenon that is making the practice of medicine more difficult and more expensive. But their patients like them, even though they may be costing them plenty.
[Arizona Daily Star 2000-10-03]

Kaiser sues state over Medicaid
Kaiser Foundation Health Plan of Colorado has filed suit against the state to recover years of back payments it claims health department officials knowingly withheld from its Medicaid HMO.
[Denver Post 2000-10-03]

GOP Aims To Restore Patients Rights
WASHINGTON (AP) — A plan to restore Medicare cuts progressed through the House even as GOP leaders made efforts to resurrect a patients’ rights measure.
[NY Times 2000-10-03]

Stress, unhealthy habits costing USA — Estimated annual tab is $250 billion
The nation spends about 25% of its total health care tab, or about $250 billion a year, on medical care for unhealthy habits and other modifiable health risks such as smoking and obesity, a new study says.
[USA Today 2000-10-03]

Monday, October 2, 2000


Q and A: A Conversation with Peter Boland, Ph.D.: Predicting MCOs’ Future By Learning From the Past
Will the electronic revolution overthrow managed care? Not necessarily, but it may help define a new role for MCOs not far in the future.

Ads are HMOs’ health plan: New members will keep groups in pink
Nearly everywhere you look this fall – on television, in the newspaper and even driving down the highway – you’ll see the appeals for your health care business. About 40 percent of Bay State HMO customers are up for grabs this fall, and all the managed-care insurers want them.
[Boston Herald 2000-10-02]

PDHI Turns Self Care Interactive
Self care for those with chronic illnesses is taking a hightech interactive approach through Protocol Driven Healthcare, Inc. (PDHI), Bernardsville.
[New Jersey Business September 2000]

Some States Fill Prescription Gap for Seniors
. . . A recent report by the Health Insurance Association of America shows that 24 states either have established or are in the process of implementing pharmaceutical assistance programs [for seniors]. This year alone, 11 states have rolled out new programs or expanded existing ones to meet the growing demand, it said.
[Reuters 2000-09-29]

Insurance law prompts flood of complaints
A New York state law that lets patients appeal insurers’ coverage denials has released a torrent of consumer dissatisfaction, generating more appeals than in any other state with a similar law.
[Crains New York Business 2000-09-04]

Drug reimportation bill could hit snag
WASHINGTON (CNN) — Just days after Republican leaders endorsed a measure allowing the re-importation of prescription drugs to the United States, a key supporter said Thursday the GOP is trying to water down the bill to please the pharmaceutical industry.
[CNN 2000-09-29]

Committee to Develop Accreditation Program For Health Web Sites
A Washington, DC-based organization better known for accrediting managed care organizations is preparing to put its stamp of approval on purveyors of e-health.
[Reuters Health via Medscape 2000-10-02]

Congress pushes proposal in last-ditch attempt to resuscitate medical savings accounts
Cheered on by some and reviled by others, the health insurance option faces its expiration date.
[AMNews 2000-10-09]

Alaska physicians settle FTC charges of price-fixing
Alaska Healthcare Network Inc., an association of 86 Fairbanks physicians, last month settled Federal Trade Commission charges that it restricted competition by fixing prices and by trying to stop new health plans from coming into the area.
[AM News 2000-10-09]

Embryo is picked to try to save sister’s life
Doctors at the Reproductive Genetics Institute in Chicago are anxiously waiting to see what happens to Maggie Nash, 6, who last week underwent a stem cell transplant at the University of Minnesota in hopes of curing her lethal blood disease. The bone marrow stem cells Maggie received in a simple transfusion came from the umbilical cord of her baby brother, and Maggie’s life hinges on the cells giving her a new bloodmaking system. Baby Adam, in turn, owes his existence to the luck of the draw—he had the immune system that his sister needed.
[Chicago Tribune 2000-10-02]

Sunday, October 1, 2000

Oxford Pays a Price for Its Rebound
Norman C. Payson has done it again, almost. Three years ago, he sold Healthsource, his troubled managed health care company, to Cigna for $1.7 billion and personally collected $90 million. Now he is getting industrywide compliments for rescuing an even worse-off company, Oxford Health Plans, the biggest health maintenance organization in the New York region, from a near-death trauma of undigested growth and management problems.
[NY Times 2000-10-01]

Basic Differences in Rival Proposals on Drug Coverage
WASHINGTON, Sept. 30 — The campaign debate over prescription drugs for the elderly has become a confusing muddle of partisan charges and countercharges, with both sides invoking the standard bogymen of health care debates, from “big government” to “H.M.O. bureaucrats.”
[NY Times 2000-10-01]

Beware of Fuzzy Insurance Argot
Jenna died two weeks ago, so the thoughts of her parents, Theresa and Bruce Gudin, are not as preoccupied by their insurance carrier as they once were.
[NY Times 2000-10-01]

Ten Things Your HMO Doctor Won’t Tell You
Rosemary Dudley trusted her HMO doctor. After all, she worked in his office as his nurse. So, in late 1997, when he told her a CAT scan showed no recurrence of the cancer she’d battled for two years, she believed him.
[ 2000-08-30]

Missives From the HMO Battlefield
Responses to “Ten Things Your HMO Doctor Won’t Tell You” article above
When we set out a month ago to educate our readers about the financial pressures HMO doctors are under and how those pressures limit care, we never anticipated the kind of response we would get.
[ 2000-09-28]

HMO OKs Some Clinical Trials
PHS Health Plans of Shelton, which has more than 500,000 subscribers in the state, will cover routine medical costs for cancer patients who enroll in trials sponsored by the National Institutes of Health or other federal agencies that oversee experimental treatments.
Hartford Courant 2000-09-29]

HMO-Contractor Dispute Cited In Access To Care
An ongoing contractual dispute between PHS, the state’s largest HMO with more than 500,000 patients, and the company it hires to manage mental health care has led to millions of dollars in unpaid bills for doctors and hospitals.
[Hartford Courant 2000-09-29]

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