04.09.09

Number of HMOs as of July 2008

Posted in Uncategorized at 5:31 am by ceo

Source: Healthleaders, Inc., Special Data Request, March 2009. (Kaiser Family Foundation)

Waste-Reduction Strategies Can Improve Health Care Quality With Reduced Costs

Posted in Uncategorized at 5:31 am by ceo

Excerpt: "In 'Imagining 16% to 12%: A vision for cost efficiency, improving health care quality, and covering the uninsured,' [Milliman sets] forth 'actuarial insights to help health care reformers develop better proposals' while reducing health care's share of the gross domestic product (GDP) from the current 16% to 12%. The Milliman team's strategies support those of the Obama Administration to reduce costly waste in health care by relying more on evidence-based medicine, using comparative effectiveness evaluations of new and existing treatments to identify those that are the most cost effective, setting quality standards and measures, making providers accountable for outcomes, encouraging informed patient choice, and promoting electronic medical records, among other steps." (Wolters Kluwer)

Impact of Two Employer-Sponsored Population Health Management Programs on Medical Care Cost and Utilization (PDF)

Posted in Uncategorized at 5:31 am by ceo

8 pages. Excerpt: "Conclusions: Our results suggest that the programs did not reduce medical cost in their first year, despite a beneficial effect on hospital admissions. If we had been able to include program fees, it is likely that the overall cost would have increased significantly. Although this study had important limitations, the results suggest that a belief that these programs will save money may be too optimistic and better evaluation is needed." (The American Journal of Managed Care)

02.15.09

Report on California Health Plans and Insurers

Posted in Uncategorized at 5:30 am by ceo

Excerpt: "Private health insurance carriers form the backbone of California's market-based health care system, providing coverage to 67% of its population. Health insurance carriers not only serve the privately insured, but also large portions of the publicly insured, in Medi-Cal, Healthy Families, Medicare, and other public programs. [Both the report and data files are linked from the target page.]" (California HealthCare Foundation)

12.15.08

[Guidance Overview] Hospital Not Entitled to Notification That Participant Was in COBRA Election Period

Posted in Uncategorized at 7:31 pm by ceo

Excerpt: "Although apparently not raised by the hospital, the IRS COBRA regulations require an indemnity or reimbursement plan to make a complete response to any inquiry from a health care provider regarding a qualified beneficiary's right to coverage under a plan during the COBRA election period. However, this provision of the regulations refers only to indemnity and reimbursement plans -- HMOs (such as the one in this case) and other plans providing services (such as walk-in clinics) are not mentioned. Nevertheless, such plans may decide to adopt the disclosure practices in the IRS regulations for provider inquiries during the COBRA election period as a way to avoid disputes and potential liability (including possible state-law misrepresentation claims), even though these disclosures technically may not be required." (Employee Benefits Institute of America)

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