Just weeks after it was signed, Cigna's agreement in New York to modify its physician ranking tool is set to have a ripple effect across the country.
Aetna and Empire BlueCross BlueShield, a WellPoint company, have signed similar agreements with New York Attorney General Andrew Cuomo's office. Aetna signed its deal on Nov. 13, while Empire followed the next day.
Aetna immediately pledged to apply the terms of its New York agreement to all of its tiered networks nationwide. Cigna made a similar pledge the same day Aetna did. WellPoint said it is not ready to make such a promise.
Under their separate deals, all three plans have agreed to make the basis of their physician ranking programs transparent to members, base those rankings on nationally recognized quality standards and submit their programs to outside evaluation.
Cuomo began looking into health plan physician-ranking programs this summer, based on concern that consumers would be directed to certain physicians based solely on cost, not quality.
"Attorney General Cuomo's model ensures transparency for both patients and doctors -- patients will now understand the criteria upon which doctors are ranked, and doctors will be able to provide input into the ranking system," said Robert Goldberg, DO, president of the Medical Society of the State of New York. Dr. Goldberg is a physical medicine and rehabilitation specialist in New York.
The Cigna Care Network designation for the plan's tiered networks is used in 58 markets from Los Angeles to Washington, D.C. At the time it signed its deal with Cuomo, Cigna said it was likely the parties would expand the reach of the agreement to cover its tiered networks nationwide, though it didn't make that announcement immediately.
[...] Copyright 2007 American Medical Association. All rights reserved.
RELATED CONTENT You may also be interested in reading:Putting the quality in rankings - Editorial Dec. 3
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Resistance builds against insurers' tiered networks Sept. 17
New York warns of lawsuit over physician rankings by United Aug. 6
Coping with rankings: Still time for challenges June 18
Comments: 0 - Date: November 26th, 2007 - Categories: Uncategorized
One doesn't have to look hard to find a personal health record system. A 2006 study by the Markle Foundation found that more than 200 PHR systems are available, and new products are continually being announced. But studies also show that availability is not translating into use, with only about 5% of all patients using PHRs. Vendors have had a hard time selling the idea of a personal medical diary to healthy consumers who see their doctors maybe once or twice a year. In addition to privacy and security concerns, patients are staying away because the PHRs on the market aren't doing much to entice them, analysts say. The industry also has failed to come up with a convincing argument for why doctors should encourage their use.
But the technology is changing, along with the scope, to make PHRs more attractive. Vendors are reaching out to health plans and employers in hopes of encouraging PHR use through incentives. And expanded data sets make the records more useful to physicians. PHRs have been welcomed by their original target audience: patients in active treatment and their caregivers, said Peter Waegemann, executive director of the Medical Records Institute, which researches electronic medical record usage and adoption. But even among early adopters, privacy and security were major concerns, said Cynthia Solomon, founder of Sonoma-Calif.-based FollowMe. One of the first known Internet-based PHRs, FollowMe was launched in 2000 by Solomon, who was caring for her chronically ill son. [...] Copyright 2007 American Medical Association. All rights reserved. RELATED CONTENT You may also be interested in reading:Microsoft's HealthVault is the latest entrant in the PHR arena Oct. 22/29 Personal health record venture gets new life Oct. 8 Insurers collaborate on standards for PHRs Jan. 1/8 An uphill climb for personal health records Column June 19, 2006
Comments: 0 - Date: November 26th, 2007 - Categories: Uncategorized
Physicians are trying to set up meetings with United Auto Workers officials to find out how the union's coming takeover of retiree health benefits from Ford, Chrysler and General Motors might affect them. But if previous transfers from companies to unions are any indication, physicians should not expect the new managers of retiree benefits to be more generous than the old ones. In fact, a union's takeover of benefits has sometimes resulted in even more aggressive cost-cutting efforts than when the benefits remained under corporate control.
"It's a huge change of mentality," said Matthew Holt, a health care consultant and vice president of research for Emeryville, Calif.-based Professional Service Solutions Inc. "Instead of saying, 'GM, you'd better give us this, this and this,' now [the union says], 'It's our money.' " With Ford workers represented by the UAW ratifying their new contract on Nov. 14, the automakers will begin fulfilling their commitment to put $54.4 billion -- $32 billion from GM, $13.6 billion from Ford and $8.8 billion from Chrysler -- into the union's Voluntary Employees' Beneficiary Association, or VEBA. Congress created VEBAs in 1928, and they served as the basis for company sick funds, a precursor to private health insurance. VEBAs are tax-exempt entities, and corporate contributions to VEBAs are also tax-exempt. A VEBA can be funded by more than one employer, but in any case it needs an IRS letter of determination to prove its tax-exempt status. [...] Copyright 2007 American Medical Association. All rights reserved. RELATED CONTENT You may also be interested in reading:UAW, Ford reach tentative agreement on health costs Jan. 2/9, 2006 Physicians brace for impact of GM's health cost cuts Nov. 7, 2005
Comments: 0 - Date: November 19th, 2007 - Categories: Uncategorized
As fewer companies establish more dominance in the commercial health insurance market, the number of plans handling workers' compensation physician networks also is shrinking. In particular, Coventry Health Care has emerged as the big fish in the workers' compensation pond. In the space of a few years, Bethesda, Md.-based Coventry has established a firm grasp on the workers business, and analysts estimate that the company now controls 65% or more of the market for national workers' compensation physician networks.
If they have not felt it already, doctors who care for injured workers could feel the weight of the company's market power. "They have become a very dominant player in the workers' comp side, and they're the only viable national network in workers' comp at this point," said Peter Rousmaniere, a Woodstock, Vt.-based consultant in the workers' compensation field. Doctors already wrestling with the high administrative costs of workers' compensation care can't afford a pay cut, said Dan Nagle, MD, a hand surgeon in Chicago. A recent UCLA study found a correlation between a decline in physician pay for workers' compensation and a decline in physician acceptance of those patients -- a trend exacerbated by practice expenses for workers' compensation cases ranging up to three times higher than Medicare, which is attributable to additional administrative and regulatory burdens. Coventry hasn't spoken publicly or to analysts in specific detail about what it plans to do with physician reimbursement. But if Coventry sends pay down even more, Dr. Nagle said, "you'll see an exodus." [...] Copyright 2007 American Medical Association. All rights reserved. RELATED CONTENT You may also be interested in reading:Medicare lets some private fee-for-service plans resume marketing Sept. 24 Court dismisses case against holdouts in class-action suit July 9
Comments: 0 - Date: November 19th, 2007 - Categories: Uncategorized
A Wall Street Journal Online/Harris Interactive Healthcare Poll found that Americans are becoming more financially sympathetic to those with unhealthy lifestyles. The early October survey of 2,267 U.S. adults found that the number of people who think it's fair to charge people with unhealthy lifestyles more for health insurance premiums fell from 53% last year to 37% this year. The same drop was seen among those who said it was fair for people with unhealthy lifestyles to pay higher deductibles or co-pays.
Paul Fronstin, director of health research and education programs for the Employee Benefit Research Institute, said he couldn't explain the changing attitudes. While insurers for some time have charged higher rates for smokers on individual plans, employers have been slow to implement such rules, he said. But more insurers, such as United HealthGroup, are developing group health plans that give healthier employees a cost break. For example, PreferredOne, a Minnesota health plan, started a new policy earlier this year that offers lower premiums for healthy people, based on blood pressure, body mass index, cholesterol levels and other wellness indicators. And a few employers have banned smoking outright -- even at home. Others assess extra monthly charges for employees who fail to meet certain health levels, or who refuse to participate in stop-smoking or weight-loss programs. [...] Copyright 2007 American Medical Association. All rights reserved. RELATED CONTENT You may also be interested in reading:It takes more than advice to stop smoking Column Nov. 26 Deductibles cut for healthy employees July 23/30 Status check on Healthy People initiatives Column Sept. 25, 2006 More workers must pay for unhealthy habits March 20, 2006
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