HHS Releases Proposed ACO Rules

March 31, 2011

Now available for public comment: 429 pages of proposed ACO rules from HHS.


Aetna to Use Medicity to Push ActiveHealth Apps to Providers

March 30, 2011

Aetna Inc. (Hartford, CT) will use the acquisition of health information exchange company Medicity as a platform for pushing clinical decision-support applications to providers – a cornerstone of the company’s ACO strategy – according to Meg McCarthy, executive vice president of innovation.  McCarthy made the comments at the Next Generation in Managed Care IT forum in New York this week, noting that while Medicity has a “good, strong core business,” the strategy is to leverage the Medicity platform to offer applications from Aetna’s ActiveHealth clinical decision-support division.  Expanded coverage appears in this month’s ACO Market News.

Question of the Day: Babette Apland

March 29, 2011

Babette Apland, senior vice president of health and care management at HealthPartners in her keynote address at the New Directions for Health Plans conference, Friday, March 25:

If ACOs are going to take risk then why do we need health plans?

Hidden Cost of Healthcare

March 23, 2011

A Deloitte study estimates that the hidden cost of healthcare in the U.S. in 2009 was $363 billion — most of which is the imputed value of “supervisory care,” i.e., taking care of a sick or disabled spouse, family member or friend.  The rest is for products and services not counted in the annual government tally of healthcare expenditures, like spending on nutritional supplements, mental health and substance abuse facilities, alternative medicine, certain ambulatory and ambulance services and weight-loss centers.

Source: Deloitte.  Based on $363 billion in estimated hidden U.S. healthcare costs in 2009.

Migration to Kaiser from Blue Shield of California

March 22, 2011

Here’s an interesting chart from the San Francisco Health Service System illustrating a steady migration among enrollees to Kaiser’s staff-model health plan and away from Blue Shield of California.  In an attempt to stem the loss of share, Blue Shield-CA has entered into an ACO with Brown & Toland and Sutter’s California Pacific Medical Center.  Complete coverage in ACO Market News.

Blue Shield-CA Withdraws Rate Hike Request

March 18, 2011

Click here for a copy of Blue Shield of California’s statement that it has withdrawn its request for another individual premium rate increase, which would have affected 340,000 members.  Complete coverage appears in the March 14 issue of Health Plan Market Trends.

Germany’s Disease Management Efforts Show Promise

March 15, 2011

According to McKinsey Quarterly, a six-year-old type 2 diabetes disease management program instituted by Germany’s national statutory health insurance system is showing signs of success.  In 2009, the program had nearly 3.2 million enrollees.  McKinsey argues that successful disease management programs tend to have five common traits: large size and scale, simple design, a focus on patients’ needs, the ability to collect data easily, and incentives that encourage all stakeholders to comply with the program.

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