contracts

A massive contract dispute between two of the healthcare industry's giants--HCA and UnitedHealthcare--has left thousands of patients in Colorado and Florida in limbo. United Healthcare says HCA is charging the insurer too much for its services; HCA disagrees, saying it just wants a fair level of reimbursement. Talks between the two sides broke down earlier this week just as the contracts expired and now 500,000 patients in those states must find a way to deal with the change while HCA and …

The Health Care Blog has a vivid rant today on Golden Rule, a perennially low-cost and shady provider of individual health policies that was acquired by United Health Care awhile back to make it an instant player in high-deductible health plans and health savings accounts. Apparently, Golden Rule claims to its customers that it has negotiated rates with providers, but its contracts with providers allow them to balance-bill the customer if the negotiated rate isn't enough--and why …

Medicare officials said they will work with two insurance companies to develop a personal health record for Medicare beneficiaries. The pilot is expected to launch in January in some areas. Capstone Government Solutions (a joint venture of BCBS of Tennessee) and Cigna Government Services were awarded CMS contracts to develop the technology involved. In a twist, both contractors say they will do the work for free. "Obviously, we'll learn a lot, as well as the government," says Cigna's Gloria Barone.

- see this Modern Healthcare article

The largest healthcare IT project on the planet continues to cause controversy. Just weeks after Accenture said that it was losing money on its UK NHS contracts and several hospitals decided to buy an alternate clinical IT system, there's a new development. A group of 20 leading computer scientists in the UK questions whether the system is secure enough and has the necessary capacity to deal with the volume of transactions it's supposed to handle. The government insists that the program is on track and is being constantly reviewed.

- read this article from the BBC

Although large insurers talk a good game on transparency, many routinely shortchange physicians in their financial dealings with them, argues AthenaHealth CEO Jonathon Bush. Bush's company, which got major play last week in BusinessWeek, is featured in today's Boston Globe. AthenaHealth provides web-based systems that help physicians survive the billing cycle by tracking claims and reducing potential errors that might result in a claim being rejected. The company has …

Miami's Jackson Memorial Hospital will get $8.6 million in a settlement with Cardinal Health, closing the book on an ugly spate between the two over a pharmacy contract dating back to November 2004. Audits found that the contract, which was sold as saving Miami Dade county as much as $4 million a year, in actuality ended up costing the company millions in higher prices for drugs and management fees. Media reports, which included embarrassing stories about trips to gentlemen's clubs that …

The world's largest healthcare IT project seems to have hit some real trouble. Richard Granger, the Director General of the UK's Connecting for Health project, has accused policymakers at the Department of Health of asking for changes well after specs were designed and contracts were settled. The degree of infighting is somewhat surprising given that the first round of installations were apparently going quite well. In an email to Margaret Edwards, the director for access and patient …

On Friday the Food and Drug Administration announced contracts for its adverse event monitoring database, a key to the agency's plan for monitoring drug safety in the future. The FDA will use the technology to look for possible signs that a particular drug may be experiencing problems. The four organizations selected to participate in the project are Vanderbilt University, Harvard Pilgrim Healthcare, Ingenix and Kaiser Foundation Research Institute. Of course, since the Vioxx withdrawal …

The Centers for Medicare & Medicaid Services is preparing to sign off in the next week or so on Medicare Advantage (MA) and Medicare Prescription drug plans (MA-PD) developed by health plans around the country. After that, competition is expected to begin in earnest among companies eager to seize their share--and possibly somebody else's--of the billion dollar Medicare Part D market. To prevent abuse, plans have been prohibited from revealing details of their contracts to …

The Centers for Medicaid and Medicare Services (CMS) announced this morning that the premium for participants in the new prescription drug benefit for Medicare will be significantly lower than expected. Officials said those signing up for the plan can expect to pay about $32.20 per month, about 15 percent less than earlier estimates. That will "make the benefit more attractive to more people," said CMS administrator Mark McClellan.

The decision is likely to be seen by critics as a …