HMOs

It's not often that prospective health plan members get pitched directly by a physician. But at Kaiser Permanente Colorado, that's exactly what's happening. The HMO has launched a program under which... Read more...

A contract fight between a group of Georgia physicians and BlueCross BlueShield of Georgia has erupted into a much-larger dispute over state rules on who plans must admit to their physician networks.... Read more...

Six years ago, California passed a new law requiring that HMO patients get timely appointments with their doctors. State regulators thought they had licked the problem--but they were a bit too... Read more...

Massachusetts Attorney General Martha Coakley has pulled together a task force to investigate whether not-for-profit hospitals and HMOs are meeting their obligations under the state's Community... Read more...

While the man is still rolling in bucks, this has gotta hurt. UnitedHealth Group former CEO has agreed to surrender more than $400 million under new agreements reached with his former employer and... Read more...

Minnesota's HMOs had a rough 2006, with enrollment and profits dropping despite premium increases that exceeded those in the year before. Enrollment fell 8.2 percent last year, down to 915,000, from... Read more...

Providers are steamed up over an Illinois proposal to force some of the state's Medicaid patients to enroll in HMOs, possibly forcing some out of their care. Because the plans haven't been popular... Read more...

A maverick California cardiologist continues to expand his burgeoning hospital empire, which now stands to challenge some of the biggest chains in the state. While the rapid pace of his acquisition is drawing attention--he's acquired six hospitals during the past year alone--what's really got the industry buzzing is the fact he's canceling all of the hospitals' contracts with health insurance plans.

Dr. Prem Reddy's Prime Healthcare Services now owns eight hospitals in California, …

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> Connecticut approved a plan that should almost triple the state's Hospital Hardship Fund for 2008. The new fund should include $30 million, up from $11 million for fiscal 2007. Article

> HMOs could boost monthly premiums 14.1 percent in 2008, the biggest rate increase in four years. …

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Working with an outside information technology vendor, Blue Cross Blue Shield of Massachusetts has begun a program designed to identify patients whose care isn't meeting clinical guidelines. The vendor, MDdatacor, will analyze data from EMRs, transcribed office notes, lab results, and cross-reference that with the plan's pharmacy and claims data. BCBS plans to use the analysis as part of its pay-for-performance program. BCBS will begin by offering the tools to a subset of its physicians, …

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