Managed care

Medical centers specializing in cancer care say that health plans are denying coverage for routine care to patients who have enrolled in clinical trials. And now, they're backing a new bill which would make this practice illegal. According to Rep. Deborah Pryce (R-OH), who sponsored the measure, only 36,000 of 1.4 million Americans diagnosed with cancer each year agree to participate clinical trials--because, providers say, insurers will cut off payment for routine clinical services if …

When talk of retail clinics first emerged, most assumed that their primary business would be cash-based. After all, if you're going to charge low prices, you might not want to take on the expense of collecting insurance reimbursement. But for many retail clinic operators, that's not how its shaping up. The most recent example comes from RediClinic, which has just announced that it will accept traditional Medicare coverage at its 46 U.S. locations. The company already has contracts in …

In Miami, medical students all get a briefing in the sometimes perplexing financial realities of their chosen profession--and some of them are a bit shocked by what they hear. For about 10 years, students at the University of Miami med school have spent a day at the headquarters of health insurer AvMed getting briefed on the latest financial issues facing practicing physicians. One-fourth of the med school's third-year class visits with health plan executives every three months. This …

Working with civil rights leader Jesse Jackson's Rainbow PUSH organization, UnitedHealth Group has launched an initiative intended to promote African-American health. The two groups are working to address disparities in the care African-American and other minority communities receive. The partners will also focus on health issues which are proving to be a particular challenge among African-Americans, including diabetes, cancer, coronary disease, asthma and obesity. UnitedHealth will give …

It may be starting as a small division, but it could become something big quickly. Hoping to get its piece of the agency's massive budget, Humana has created a unit which will help the U.S. Department of Veterans Affairs care for veterans who are eligible for its benefits. Humana already gets roughly three quarters of its premium revenue from government sources, largely from CMS. Now it wants more government income. To jump start the new division, Humana Veterans Healthcare Services, it …

While it's not clear how, if at all, this might have affected his performance, it's beginning to look like a personal relationship may have lead to WellPoint CFO David Colby's ouster. Only days after a California woman filed suit against him, claiming that he had promised to give her his $4 million mansion, Colby was out the door. Colby is still married to his second wife, though he's engaged in …

UnitedHealth Group is facing a host of legal troubles in California, where both regulators and a large group of independent physicians are accusing the plan of financial and operational misconduct. Two of the state's agencies have begun investigating whether the health plan has been making late and inaccurate payments, as well as restricting patient access to care. The agencies are responding to a high volume of complaints alleging that the plan held up physician payments and paid claims …

Beefing up its Medicaid managed care offerings, Aetna has acquired Phoenix, AZ-based Medicaid management firm Schaller Anderson for $535 million. Schaller Anderson serves more than 1.3 million beneficiaries and manages more than $3 billion in benefits. It has about 1,800 employees in nine states. The company was started by Joseph Anderson and Dr. Don Schaller, who founded the company more than 20 years ago after helping to create Arizona's Medicaid program. The buy follows a previous deal …

WellPoint's finance chief has been pushed out of the company, accused of unspecified financial improprieties. Effective immediately, WellPoint senior vice president and chief accounting officer Wayne DeVeydt will take over as executive vice president and CFO. The company demanded that CFO David Colby resign after it concluded that Colby had violated the company's code of conduct. This came despite Colby's having been promoted only two months ago to vice chairman.

The company …

Health plan UnitedHealthcare launched a plan yesterday to name hospitals that agree to submit information on one aspect of cardiac care to a central registry. Under the program, UnitedHealthcare will certify hospitals as "premium" cardiac care centers if they agree to submit performance and outcomes data on their use of implantable cardiac defibrillators to the Implantable Cardioverter Defibrillator Registry (ICDR). The ICD registry, which was developed by the American College of …