News for Payers

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High private-payer margins can lead to negative Medicare margins

 Richard Pizzi March 18, 2010
An article published this week in Health Affairs found that hospitals with strong market power lose money on Medicare patients because these hospitals tend to have high cost structures.
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Emdeon to bolster payer offerings with HTMS deal

 Eric Wicklund March 18, 2010
Emdeon is boosting its portfolio of service offerings to payers with the planned acquisition of Healthcare Technology Management Services.
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CMS won't enforce 'direct supervision' policy for critical access hospitals

 Richard Pizzi March 17, 2010
The Centers for Medicare & Medicaid Services has instructed Medicare contractors not to evaluate or enforce the "direct supervision" requirement for therapeutic services furnished in calendar year 2010 to outpatients in critical access hospitals.
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Brand-name drug prices are rising in 2010

 Chelsey Ledue March 17, 2010
A Kaiser Family Foundation analysis finds that prices for commonly used brand name drugs are rising in 2010.
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New AMA tool to help doctors correct managed care contracts

 Chelsey Ledue March 17, 2010
A new online resource from the American Medical Association is designed to help physicians who are seeking alternatives to one-sided contracts offered by some managed care organizations.
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Vendor Notebook: Craneware, Inc., signs contract to deploy new toolkit

 Eric Wicklund March 15, 2010
Craneware, Inc., based in Orlando, Fla., has signed multi-year contracts with the North Shore-LIJ Health System on Long Island, N.Y., and the HealthEast Care System in Minnesota to implement the Chargemaster Corporate Toolkit, Online Reference Toolkit and Bill Analyzer solutions.
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Economist says episode payments will bend healthcare cost

 Patty Enrado March 15, 2010
Episode payments – case rates for major acute interventions and chronic conditions – are the best approach for payment reform, according to a University of California economist.
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Creative payment reform initiatives abound nationwide

 Patty Enrado March 12, 2010
Innovative programs, such as tying the payment system to the delivery system, could help bend the healthcare cost curve, according to Karen Davis, president of the Commonwealth Fund.
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Survey: Health insurance and access to care not so closely linked

 Chelsey Ledue March 10, 2010
Having health insurance is not synonymous with having access to healthcare, according to a survey released by the Center for Healthcare Research & Transformation.
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Medicare nixes contract with Fox Insurance drug plan

 Chelsey Ledue March 10, 2010
The Centers for Medicare & Medicaid Services has terminated its contract with the Fox Insurance Company.
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American Well brings online care platform to New York

 Eric Wicklund March 10, 2010
American Well, which offers Web-based physician visits for members of health plans in Hawaii and Minnesota, has landed another contract closer to home.
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Michigan insurers abandon merger plans under federal pressure

 Richard Pizzi March 10, 2010
Blue Cross Blue Shield of Michigan's subsidiary, Blue Care Networks of Michigan, abandoned plans to purchase Physicians Health Plan of Mid-Michigan after the U.S. Department of Justice said it would file an antitrust lawsuit to block the acquisition.
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Virginia is the first state to pass national healthcare nullification law

 Chelsey Ledue March 05, 2010
Virginia became the first state to enact legislation to prevent its citizens from being mandated to purchase health insurance or participate in any healthcare system.
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CMS to hold claims for 10 days

 Richard Pizzi March 02, 2010
The Centers for Medicare & Medicaid Services has instructed its contractors to hold claims containing services paid under the Medicare physician fee schedule for the first 10 business days of March.
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Study says how care is paid for could impact outcome

 Molly Merrill March 01, 2010
Whether an individual is treated at a hospital reimbursed by Medicare or at a Department of Veterans Affairs Medical Center could contribute to what happens to a patient after their release, says a recent study.
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Building efficiencies into the payment process

 Richard Pizzi February 26, 2010
Healthcare providers and payers don’t often see eye-to-eye on reimbursement issues. But that’s ever the more reason to get them together in the same room, better yet at the same table.
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Membership continues to fall for top 8 health plans

 Chelsey Ledue February 26, 2010
Between September 2008 and September 2009 the nation’s top eight health insurance plans saw membership decline by 1.7 million.
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BCBS saves, keeps jobs in Michigan

 Mike Miliard February 26, 2010
Like everywhere, Detroit has been hit hard by this recession – only much, much worse.
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Market power of California providers foreshadows national health reform challenges

 Richard Pizzi February 25, 2010
The growing market power of hospitals and physicians to negotiate higher payment rates has gone largely unexamined, according to a study by the Center for Studying Health System Change.
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AMA, Grassley put heat on insurance companies

 Diana Manos February 24, 2010
Health plans are taking the heat this week with Sen. Charles Grassley's (R-Iowa) demand for an explanation for Wellmark's rate hike in Iowa and the American Medical Association's new report showing health plans face too little competition nationwide.
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