Managed Care Contracting & Provider Payment

CO-OP Primer Article is Published

Here is an article that I wrote with Leah Stewart of Beatty, Bangle & Strama, PC of Austin, Texas.  It was published by the American Bar Association's Health Lawyer, so has an understandably legal slant.  It gives an overview of the Consumer Operated and Oriented Health Plan Program to date.  Since then, I've been up to my ears with filing applications on behalf of CO-OPs and working to get them formed.

Anyhow, for your reading pleasure:  The Health Lawyer Article

Robert Wood Johnson Article on CO-OPs

As regular readers know, I have been working on developing Health Care Cooperatives (called "Consumer Operated and Oriented Plans" or "CO-OPs") under a program created by the federal health care reform law.  The Robert Wood Johnson Foundation recently published an article by Bradford H. Gray, PhD. giving an overview and early assessment of the CO-OP Program.  The article can be found HERE.

I hope you'll find it interesting.

CO-OP Proposed Rule Is Posted

On Monday, HHS issued its set of proposed rules for the Consumer Operated and Oriented Plan Program.  I wrote about it earlier here and that article provides the context for the cryptic notes that follow.   These same proposals appear in this morning’s Federal Register.  Although I am still going through the rule, some initial notes:

COOPs: A Little Known Provision of the Health Reform Law

There is a provision of the Patient Protection and Affordable Care Act (the “ACA”) that seems to be a “sleeper” in the news, but it could have a very large impact on the market for health insurance.  The provision, Section 1322 of the ACA, requires the federal government to provide start up funding for “non profit, member-run health insurance issuers”. 

Medicare Advantage Plan Network Adequacy: What does a Medicare Advantage Plan have to show? What do Providers Need to Know?

Effective for the 2011 plan year, the Center for Medicare and Medicaid Services ("CMS") has fine tuned its requirement that Medicare Advantage coordinated care plans maintain an “adequate network”.  Providers may benefit from knowing what CMS wants to see.

AMA Releases Its Payor Payment Report Card

Following closely on the heels of its recently released Payer Code of Conduct, the AMA has just today released its 2010 National Health Insurer Report Card.  Among the key findings:

Quick Post: Fierce Health Posts 2009 Health Insurer CEO Compensation

Yesterday, FierceHealth posted a list of the compensation paid to CEOs of the largest health insurers.  You can find it: Here

Happy Reading!

What will health reform mean to managed care contracting?

The dust has not even begun to settle on some of the most significant changes to occur to health care since the inception of the Medicare program.  The Patient Protection and Accountable Care Act (“PPACA”) has affected every segment of the health care industry: insurers, patients, employers and providers.

Paperless Contracting is Coming.

I have heard from several payors lately about steps to streamline the costly, time and labor intensive contracting process.  Aetna announced yesterday that it will begin using a paperless contracting process for its provider contracting.  The process, which involves e-mailing the agreement and electronic signatures is said to save postage expense and reduce processing time.

The Red Flag Compliance Train is coming down the Track and Payors are Asleep at the Switch.

Now, as we all know, the deadline for enforcement of the Red Flag Rules is looming … May 1^st.  Providers are struggling to implement red flag compliance policies.  It’s another big PROVIDER compliance panic.