Volumes May Improve, but Medicaid and Medicare Could Pressure Hospitals in 2012From Health Plan Week - Despite the still sluggish economy and low admission rates, publicly traded hospitals maintained their profitability in 2011. But continued low patient volume, combined with growing enrollment in low-paying government programs, could give hospitals more incentive to pressure insurers for higher reimbursements during contract negotiations. Michael Waterhouse, an equity analyst at Morningstar, Inc., says patient volume among the hospitals he tracks is improving, but says it isn’t likely to surge this year. Read more
Blues Plans Eye Investments in Marketing Technology to Prepare For Public ExchangesFrom The AIS Report on Blue Cross and Blue Shield Plans - As health insurers gear up to prepare for the launch of public exchanges in 2014, most Blues plans this year will devote more resources not only to technological and other infrastructure improvements related to exchanges, but also increased marketing and retail investments in order to facilitate what will be significant growth in the individual market. A number of Blues plans and consultants interviewed by The AIS Report say that the exchanges… Read more
As States Update Systems, Build New Ones, IT Vendors Face Challenges, OpportunitiesFrom Inside Health Insurance Exchanges - Millions in federal grant funding and a flurry of requests for proposals (RFPs) ensure that information technology (IT) vendors will have little idle time in 2012. While many states are reluctant to move forward on exchange development until the Supreme Court renders a decision on the constitutionality of the individual mandate requirement, other states are pushing hard to build IT systems that will allow them to develop an insurance exchange… Read more
2012 Outlook: Dual-Eligible Market Beckons MA, Medicaid Plans, but New Initiatives Pose Questions (with table: Status of Initiatives in…From Medicare Advantage News - If there is one key market segment that Medicare plans — and Medicaid ones — will focus on in 2012, it is Medicare-Medicaid dual eligibles. After years of discussion, it looks as though both the federal government and states will accelerate dramatically implementation of programs to improve quality and reduce costs in care for duals, and the result will be big opportunities for plans. Read more
2012 Outlook: Despite Buzz, Narrow Networks Haven’t Seen Widespread Adoption, Say Experts From Drug Benefit News - According to predictions made by several PBMs and pharmacy benefit consultants in DBN’s last Outlook poll, 2011 was slated to be the year of the narrow network (DBN 1/7/11, p. 1). From incentive-driven networks to limited pharmacy panels, plan sponsors were supposedly chomping at the bit to achieve savings through these restrictive network designs. Read more
Hospitals Settle Big-Dollar Stark, Kickback Civil Money Penalty Law Cases with OIGFrom Report on Medicare Compliance - Whidbey Island Public Hospital District in Coupeville, Wash., agreed to pay $858,571 to settle allegations that it violated the civil money penalty law related to Stark and kickbacks, the HHS Office of Inspector General said in late December. That’s a large fine for a single-hospital CMP settlement, although Whidbey is not alone. Read more
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