AU.S. District Court judge has ordered Blue Cross and Blue Shield of Ohio to relinquish its trademarks — including its name. The health insurer, as one might expect, has filed an appeal. The national Blue Cross and Blue Shield Association sent the Cleveland-based company a letter saying that the plan's license has expired and that, in any event, it violated its license when it decided to sell most of its assets for $299.5 million to the for-profit Columbia/HCA hospital chain. Under the merger agreement, if BCBS of Ohio loses its trademarks, the purchase price falls by $50 million. A spokesman for Columbia/HCA couldn't say when the merger might be final.

As of Dec. 5, the plan was to cease using Blues marks in its marketing materials, stationery and subscriber cards. It's not clear how current provider contracts will be affected.

The association's board of directors is considering bids from other Blues plans to take over the region's license. Cincinnati-based Anthem Blue Cross and Blue Shield is one possibility.

For several years the Blues association has undergone an internal debate about whether licensees may operate as for-profit plans. Two licensees
— Blue Cross of California and BCBS of Georgia — have converted fully to for-profit status, but the Ohio plan seemingly went too far.

A health plan and a medical school in Boston have founded a program that will examine ethical problems in managed care.

It will be funded by the Harvard Medical School/Harvard Pilgrim Health Care Department of Ambulatory Care and Prevention, and by the school's Division of Medical Ethics.

Internist Steven Pearson, associate director of the Center for Ethics in Managed Care, says many managed care organizations have wanted to address ethical issues, but often could not find adequate resources. "We are not going to be the judgment squad on other health plans," says Pearson. "What we hope to do is help others come together to build a framework for self-assessment."

Starting this month, the center is conducting an ethics survey of Harvard Pilgrim members about physician-patient relationships and about how they feel about the plan's switch from staff-model to group-model status. The center may also assist in developing a so-called ethics report card that could be used either as a self-assessment tool or as part of an accreditation program.

The center also plans to sponsor a yearly conference modeled on its first conference, "Professionalism and Ethics in Managed Care," which was held in early November.

Equifax Inc. is leaving the physician credentials verification business.

Better known for collecting personal credit and insurance information, the company in fact is selling all of its health information units. Equifax entered the health information sector a few years ago through acquisitions, and has spent millions nurturing its health care business since.

Considered a significant player in the credentials verification industry, with unquestionably the deepest pockets, the Atlanta-based company recently sold its Health Administrative Services unit to privately-held Centra Benefit Services of Dallas. It has an agreement to sell its Health Analytical Services to HCIA of Baltimore.

Equifax increased the value of Equifax Medical Credentials Verification Service in April when it launched the first on-line data base to allow immediate access to credentials.

The Medical Society of the District of Columbia, a regional affiliate of the American Medical Association, says a single-payer health insurance system should be considered for the United States.

The House of Delegates of the nearly 3,000-member society supported the concept at a recent meeting. It doesn't give blanket endorsement to the type of single-payer system found in Canada, but does consider it an option. Wayne D. Blackmon, M.D., society president, told the Washington Post that the endorsement reflects doctors' deep frustration with managed care's low reimbursement and expanded oversight.

The delegates stipulated that a single-payer system would have to meet 15 requirements, including universal and comprehensive coverage and maintenance of fee-for-service payments, physician autonomy and patients' freedom to consult a specialist directly.

A new survey confirms the startling findings of a previous study: Americans don't know or understand the term "managed care."

Louis Harris and Associates found that 55 percent are unsure about the term, and about one-third don't recognize "health maintenance organization." Three-fourths say they've never heard of "fee-for-service health insurance."

The study's author, Stephen Isaacs, says that health plans, providers, employers and the government need to improve their educational efforts.

A half-dozen health insurance plans have their eyes on Boston's vast Medicare population. The entire Massachusetts market has an estimated 900,000 Medicare-eligible people, many not in HMOs.

The largest Medicare HMO in the region is Tufts Associated Health Plans' Secure Horizons. Tufts licensed the name and the program from PacifiCare Health Systems of Cypress, Calif.

According to the Health Care Financing Administration, which oversees Medicare, Tufts has 40,000 members, nonprofit Harvard Pilgrim Health Care counts about 36,000, Fallon Community Health Plan has 28,000 and U.S. Healthcare nearly 12,000.

Tufts recently expanded Secure Horizons' physician panel by adding 150 primary care doctors covering Boston and the South Shore. It was the first major managed care contract for their network, Primary Care LLC, since they organized it last January.

Tufts began its Medicare program in late 1994. The plan's primary care physician panel for its Medicare members has grown from 100 to about 1,000 today.

— Paul Wynn

A recent survey of 80 HMOs in 13 states with mature managed care markets found that 58 percent plan to offer alternative therapies within two years. Acupuncture and chiropractic are most popular with patients and consequently most likely to be offered.


Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.