By Robin Fisk for health care providers, practitioners, insurers and managed care companies to address issues that arise in the relationship between them.
On Tuesday, United HealthCare agreed to the terms of a
settlement proposed by the New York Attorney General to end the investigation
into the practices if its subsidiary, Ingenix, Inc.(Link
to earlier post about the investigation.)The settlement, requires United HealthCare to
This
past November 18th, the 1st Circuit overturned a lower
Court decision and held that an “innovative” New Hampshire approach aimed at
curbing increasing drug prices was not anun Constitutional abridgement of free
speech.The law prevents companies that
mine prescription data from selling it to pharmaceutical companies for use by
their drug detailers to attempt to influence prescribing patterns.
A recently announced draft bill would present yet another
form of transparency in the health care marketplace:disclosure to employees of what the employer
pays for their health coverage. It may have some interesting side effects.
Here is another consumer rating site to add to the growing list:
"WhereToFindCare.com" Similar in concept to "Angie's list", this free site is touted as a place where "Anybody can rate [a health care provider] whether they were a patient, caregiver or visitor."
Yesterday, the Chicago Tribune ran a story describing the AMA's new insurer report card aimed at "hold[ing] health insurance companies accountable for making claims
processing more cost effective and transparent and to educate and
empower physicians so they are no longer at the mercy of a chaotic
payment system that takes countless hours away from patient care."
Link to Chicago Tribune Article: Here Link to AMA "Cure for Claims" press release: Here
The American Association of Health Insurance Plans has issued a statement noting the improvements in claim payments brought on by electronic claim processing.
I received a call from a hospital describing an increasingly
common scenario:a potential patient calls
asking for the price of an outpatient CT scan; either because he is uninsured
or is covered by insurance with a deductible.The caller had already called several other providers and this
hospital’s price was higher.Even if the
caller was covered by a high deductible plan (and was therefore entitled to pay
the insurer’s negotiated rate) the hospital’s charge for the scan was still higher
than the competitors’ prices – especially outpatient scanning sites.
The hospital wanted to know whether it could match their
“competitor’s” price for the MRI.
I discovered a web site dealing with transparency initiatives - whether by health plans, states or Medicare. It is "AboutHealthTransparency". It appears quite comprehensive and is well organized (where do they find the time?!) If you're interested in tracking a specific effort at tiering or ratings, it is worth checking out. Happy researching!
I sometimes participate on a list serve of attorneys who work in
managed care - whether from the provider or payor “side of the table”. An attorney representing a group of
specialty physicians recently posted asking how he could get information about
the rates insurers paid to other area physicians practicing in the same
specialty. His suspicion was that his client's insurance contracts were outdated and their payment rates were
significantly below the market.
On
April 1st, a consortium of physician organizations, quality
advocates and health plans announced that they had agreed on a set of principles
for health plans to adopt to their programs to evaluate and rate physicians. The purpose of the principles was to
recognize the need for consistency and standardization in measures.
Several state and national insurers have agreed to follow a
code for their physician quality ranking efforts. The code is contained in “first in the
nation” legislation supported by the NY Attorney General and is announced as a
major attempt to coordinate the insurer’s various health care quality
transparency initiatives and to provide transparency for the ranking process.
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