11.07.08

Insurers Hire Radiology ‘Benefits Managers’ to Vet Scanning

Posted in Uncategorized at 11:31 pm by heaven

Excerpt: "Health insurers are increasingly relying on outside firms to help rein in the skyrocketing costs of imaging scans like MRIs. But when these middlemen clash with doctors about what tests are needed, consumers can get caught in the crossfire. Big insurers including Aetna Inc., WellPoint Inc. and Cigna Corp. have hired so-called radiology benefits managers, or RBMs. Health plans say they want to ensure that doctors use high-tech scans only when it is clear that patients will benefit." (The Wall Street Journal)

10.09.08

The Changing Effect of Managed Care on Physician Financial Incentives

Posted in Uncategorized at 6:03 pm by heaven

Excerpt: "Objective: To examine how managed care affects physician financial incentives to reduce services to their patients, particularly how this relationship has evolved over time and whether the effects of capitated managed care and noncapitated managed care are different. . . . Conclusion: Managed care and traditional indemnity plans were substantially more similar in their effects on physician incentives to provide care by 2004-2005 than they were just 3 years earlier. This should alleviate policy concerns that managed care is providing physicians with the 'wrong' financial incentives to provide care." (The American Journal of Managed Care)

09.01.08

Healthier Consumers, Customers and Communities: The Hannaford Dynamic (PDF)

Posted in Uncategorized at 9:22 am by heaven

4 pages. Excerpt: "This issue of our 2008 Perspectives series looks at how Hannaford Supermarkets used a 'quality paradigm' -- focusing on quality care, efficiency, evidence-based medicine and cost control to dramatically lower its health care spend while lifting employee satisfaction and perception of quality." (Towers Perrin)

08.29.08

Fight Back When Your Health Plan Says No

Posted in Uncategorized at 1:40 pm by heaven

Excerpt: "Bernadine Healy, MD, former director of NIH and now health editor at US News & World Report, has written a chilling piece on how easy it is for insurers to deny claims. From the article, 'How Crafty Health Insurers Are Denying Care' . . . ." (Health Insurance Consumer Information)

08.27.08

Patients Suffer As Care, Coverage Limits Collide; Physicians Say Insurers Intrude on Treatment

Posted in Uncategorized at 2:40 am by heaven

Excerpt: "Increasing healthcare costs and an influx of expensive drugs and tests, combined with an aging population, set off a healthcare crisis in the United States. Contending with soaring costs, insurers changed the business of health care by requiring preauthorizations, mandating cheaper drugs, and tightening controls on treatment decisions. But among the first casualties of these changes, many physicians said, was the doctor-patient relationship." (Toledo Blade)

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