Managed care

In the past, a patient's dental health didn't get a lot of attention from doctors, who assumed that only dentists needed to consider the effects of gum disease. But as it turns out, gum disease is far more dangerous than it appears. Research conducted over the past five years is suggesting that long-term gum disease can speed the progression of diabetes, cardiovascular disease, stroke, pregnancy complications and several other conditions. What's more, such infections can increase surgical …

It's crackdown time in North Carolina, which saw a nearly 30 percent increase in physicians disciplined by the state medical board last year. Critics had previously chastised the medical board for being too easy on doctors, but things have changed, with 171 physicians being disciplined in 2006. The total number of disciplinary actions has nearly tripled since 2002. Last year's jump isn't just a statistical anomaly, either. While the total number of doctors disciplined last year went up by …

In an attempt to keep patients taking their drugs, UnitedHealthcare has cut the co-payment for a group of asthma inhalers. This is not a new strategy for the health plan, which previously moved branded test strips and insulin products for diabetes into its lowest co-payment tier. This time the insurer's pharmacy benefit manager, UnitedHealth Pharmaceutical Solutions, has slashed the co-payment chlorofluorocarbon-free asthma drugs like Xopenex to its lowest tier, leaving patients to bear …

Bowing to public pressure, Massachusetts officials are planning to exempt almost 20 percent of uninsured adults from the state's health insurance mandate. Under the state's reform law, all adults would have to have health insurance by July 1, and they'd face a penalty if they didn't have insurance by December 31. However, officials have concluded that even bare-bones, high-deductible insurance will be too expensive for about 60,000 people who make too much to qualify for state subsidies, …

California Gov. Arnold Schwarzenegger (R) is considering some aggressive steps to push all citizens into health insurance plans. Under this proposal--one of several being considered by the administration--the state would track down people who refuse to buy health insurance, force-enrolled in a plan and fined until they pay the premiums. Schwarzenegger has also proposed attaching the wages of people who don't buy into a health plan, or boosting their state income tax debt. To find the …

With a new policy poised to take effect which would impose fines for out-of-network lab referrals, UnitedHealth Group has gone too far, doctors say. Late last year, UnitedHealth struck a 10-year deal with LabCorp making its locations the preferred in-network testing facilities for the health plan's 28.5 million members. While that didn't raise eyebrows, UnitedHealth's next step did. UHG has now warned doctors that if they referred to other labs frequently, it could potentially fine them …

A proposed merger between Pennsylvania-based health plans Independence Blue Cross and Highmark drew criticism yesterday, with politicians and consumer groups raising questions about the impact of the deal. The proposed merger, which has already been approved by the boards of the two plans, would create the nation's third-largest health insurer, with 9 million beneficiaries and more than …

New research suggests that women with high-deductible plans may face significantly higher expenses than men, due primarily to routine screenings and services such as mammograms, cervical cancer vaccines, Pap tests, birth control and pregnancy care. According to the research, which was published in the Journal of General Internal Medicine, men under 45 years old paid less than $500 per year, but women spent more than $1,200 based on 2006 dollars. Harvard Medical School researchers …

WellPoint, by some measures the nation's largest health plan, has decided to take some aggressive steps to promote its new member health index (MHI). WellPoint has begun tying the index, a comprehensive measure of health improvement in its 34 million enrollees, directly to the compensation of every WellPoint employee. While it's increasingly common to compensate physicians for member health improvements, tying all employee bonuses to such a measure may be a first. The MHI includes 20 …

A new study suggesting that stents don't help non-emergency cardiac patients more than drugs could soon change how insurers reimburse for such treatments, observers say. The recent New England Journal of Medicine study, which looked at 2,287 non-emergency patients, found that angioplasty and stenting didn't save lives or prevent heart attacks, though it did reduce chest pain. Right now, roughly 50 to 80 percent of angioplasties are performed on non-emergency patients, with …