health insurer

MGMA plans 50-state payer rating survey

Anne Zieger — Mon, 20 Oct 2008 17:24:31 -0400

The Medical Group Management Association has set plans to conduct a 50-state survey of health professionals asking them to rate various aspects of their relationship with payers. The survey, which closes October 24, is open to both MGMA members and non-members. Those who participate in the survey will be mailed a copy of the results.

While the survey will specifically target the top five health plans in each state, it will ask each respondent the same questions. "Our intent is to see whether there's trends or problems we can identify and provide feedback to the payers," said Anders Gilberg, vice president of public and private economic affairs with the association.

Questions contained in the survey include how satisfied the respondent is with the payer's provider credentialing process, how long it takes for the payer to respond to their questions, how satisfied they are with the payer's website as a means of conducting business and how much leverage their practice has during contract negotiations.

The survey is one of a growing number of efforts designed to rate aspects of payer performance, including a recent national payer survey by the AMA and a regional one by the Massachusetts Hospital Association.

To learn more about MGMA's survey:
- visit the MGMA survey page

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GA Blue plan sends benefit letters to wrong addresses

Anne Zieger — Wed, 30 Jul 2008 10:54:00 -0400

It all goes to show you that even without electronic medical records in place, computers can screw things up. This week, Georgia's largest health insurer has concluded that it sent about 202,000 benefits letters containing both personal and health information to the wrong addresses last week. Blue Cross and Blue Shield of Georgia said the mailings were largely Explanation of Benefits letters, which include the patient's name and ID number, the name of the medical provider that delivered the service and the amounts charged and owed. Not only is the mistake a possible invitation to identity theft, but it could turn out to be a HIPAA violation as well.

The Blue plan, which has 3.1 million Georgia policyholders, said that the error occurred due to a change in one of its computer systems that had not been tested properly. Executives say that they've altered the system so this kind of mistake can't happen again. Meanwhile, the plan--a subsidiary of giant WellPoint--is providing free credit monitoring for affected patients for one year. It's also giving written notice to policyholders whose names were on the EOBs, and compiling a list of those who received other members' EOBs in error.

To learn more about the breach:
- read this Atlanta Journal-Constitution article

Related Articles:
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Transparency getting big boost in Boston metro

Tue, 10 Jun 2008 06:59:58 -0400

A few developments are emerging in Boston that suggest that it may become one of the leading regions in the U.S. for disclosure of price and provider ranking information.

On one hand, a growing number of health plans are beginning to rate individual physicians or making plans to do so. The latest are Tufts Health Plan, the state's third-largest health insurer, which is expanding its "Navigator" doctor rankings plan. Meanwhile, Harvard Pilgrim Health Care is considering offering health plans with doctors rankings to consumers not covered through the commission negotiating municipal and state employee coverage. These moves already excited a fight over the Group Insurance Commission's rankings, which are opposed by the Massachusetts Medical Society as being unduly influenced by physician fees.

Meanwhile, by late summer, the Massachusetts Health Care Quality and Cost Council will soon launch a website listing insurance payments for as many as 40 procedures, including about 20 inpatient and 20 outpatient procedures.

To learn more about the dispute:
- read this article in The Boston Globe
- read this Boston Business Journal piece

SEC backs universal health insurance ballot measure

Tue, 27 May 2008 06:59:55 -0400

While most of the discussion of universal healthcare coverage takes place outside of the corporate arena, some activist shareholders may have succeeded in forcing the discussion into stockholder debates. Of late, groups of public company shareholders such as religious groups and labor unions have pushed a proposal asking shareholders to vote on a statement endorsing universal health insurance coverage. The statement asks companies to offer official support for universal, continuous, affordable health insurance. Many companies have resisted vigorously, including, interestingly enough, health insurer UnitedHealth.

Their tactic may be working. Over the past several months, the Securities and Exchange Commission has told a group of large public companies--including Boeing, General Motors, United Technologies, Wendy's International and Xcel Energy--that they must include the proposal in their proxies. Generally speaking, companies don't have to let shareholders vote on proposals if they don't relate to a company's ordinary business operations. However, the SEC said that it sometimes is appropriate for shareholders to express views by voting on significant social policy issues--and that it feels healthcare has reached the level of importance necessary to meet such a standard.

To learn more about this issue:
- read this piece in The New York Times

DC health mandate generates pullout threat from provider

Tue, 06 May 2008 06:59:55 -0400

As states and other governmental bodies consider health reforms, there have been some repercussions in the business community, of course. In DC's case, the impact could be quite severe, as the region's largest private healthcare provider may pull its physician network--along with its planned $5 million annual contribution--out of the region if DC's current reform package goes through. The District's Healthy DC legislation originally would have required that its 45,000 uninsured residents receive special subsidized health coverage, which would be available for premiums of between $20 and $100 per month, or else pay a $250 fine. It would be made available to those making more than $21,000 per year who couldn't afford traditional coverage.

The city had entered into a contract with CareFirst BlueCross BlueShield, a not-for-profit health insurer, to provide the special coverage. However, CareFirst has since expressed concerns that the $50 million program might not be financially viable.

To learn more about the dispute:
- read this Washington Post article
- read this statement from D.C. Councilmember David A. Catania, who backs the reforms

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WellPoint stops paying for never events

Thu, 03 Apr 2008 07:59:58 -0400

Health insurer WellPoint has taken a stand that most other U.S. insurers are likely to follow: It has announced that it, in coming months, will no longer pay for care resulting from serious medical error. WellPoint will start by denying payment for three never events: foreign objects left in patients after surgery, operations on wrong body parts and operating on the wrong patient. It's also refusing payment for hospital-acquired injuries, pressure ulcers, air embolisms, blood incompatibility, catheter-associated urinary tract infections, vascular catheter-associated infections, hospital-acquired injuries and chest infections after CABG. It is, of course, following CMS's lead, which announced last year that it would stop paying for treatment related to certain adverse events.

To learn more about WellPoint's decision:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
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Study: Wrong-site surgeries, close calls are common. Report

PA puts hospital quality data online

Wed, 19 Mar 2008 07:59:55 -0400

A Pennsylvania group has launched a new website offering quality reports that compare hospital performance and outcomes for the state. On the site, which includes data from all 162 primary acute care hospitals in the state, users can look up which hospitals have the best record in relation to certain conditions like heart attacks, heart failure or rates of hospital-acquired infections. Users can compare hospitals to each other, as well as to state and national averages for quality of care. They also can search for individual hospitals by ZIP code, county or name. The hospital data, which is being published by the Pennsylvania Health Care Quality Alliance, comes from CMS, the Pennsylvania Health Care Cost Containment Council and the Joint Commission. This makes Pennsylvania one of less than a dozen states to offer such comparative information.

To learn more about this effort:
- visit its site
- read this Associated Press article

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DOJ OKs UnitedHealth buyout of Sierra

Tue, 26 Feb 2008 06:59:58 -0500

If it's willing to divest most of its Medicare Advantage business in the Las Vegas metro, UnitedHealth Group may proceed with its $2.6 billion buyout of Sierra Health Services, the U.S. Department of Justice has ruled. At the same time, the Nevada Attorney General announced that it had reached a parallel settlement under which it would also allow the deal to proceed. Sierra, which has revenues of $1.9 billion, is the largest health insurer in the Las Vegas metro area.

The original deal would have given UHG a 94 percent share of the Medicare Advantage market in Las Vegas, an obvious non-starter from an antitrust standpoint. The deal also raised the hackles of many observers, including the AMA. Now, Humana has been named as a possible buyer for the UHG's Medicare Advantage book of business in Las Vegas, the DOJ announcement said. UHG currently has 82,000 seniors enrolled in its Medicare Advantage plans, which generate $840 million per year.

To learn more about the deal:
- read this Modern Healthcare item (reg. req.)
- read the DOJ press release

Related Articles:
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AMA tries to block UnitedHealth acquisition. Article

SPOTLIGHT: Will NY investigation distract UnitedHealth?

Fri, 15 Feb 2008 06:59:52 -0500

Yesterday, the New York attorney general slapped UnitedHealth Group by announcing that it would sue the health plan for allegedly underpaying for services. Ordinarily, a company the size of UHG--the nation's largest health insurer--would set its legal department on the matter and turn executives' attention elsewhere. But in this case, given that the probe is also taking a hard look at how subsidiary Ingenix works with health plans nationwide, the AG's actions could have a meaningful effect on UHG's business, some observers say. Article

BCBS of TN plans to share doctor ratings, prices

Thu, 07 Feb 2008 06:59:57 -0500

BlueCross BlueShield of Tennessee, the state's largest health insurer, said this week that it plans to begin offering doctor quality ratings and cost data to consumers in April. The Blue plan will offer its members secure online access to data on how much doctors charge for an array of procedures, as well as ratings on whether their patients got the right treatments and tests for some conditions.

The plan is stirring up the same objections here that it has in other states, notably that the health plan will steer patients to cheap doctors regardless of quality, that the data itself (drawn from claims) may be flawed, and that ratings may make doctors who take on the sickest patients look bad unfairly.

In a nod to recent physician rating guidelines issued by the state of New York's attorney general, BlueCross has incorporated some of the state's best practices, including disclosing how doctors are ranked, and giving the physicians a chance to appeal inaccurate ratings. However, it looks as though a few other key aspects of the New York model, including external ratings audits and using risk-adjusted data, aren't part of BCBS of Tennessee's plans.

To learn more about the health plan's approach:
- read this piece from The Tennessean

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