May 08, 2008
Health 2.0 Consciousness Dawns - Even In Jacksonville, FL!
by BRIAN KLEPPER Next Thursday, Matthew, Michael Millenson and I are converging at a Robert Wood Johnson Foundation conference on public reporting of health care pricing/performance information in Amelia Island, FL, three short barrier islands north of my home in...May 8, 2008 in Brian Klepper, Economics, Health 2.0, Health Plans, Hospitals, Policy, The Industry, Transparency | Permalink | Comments (1)
May 07, 2008
Health Plan Illiteracy: study finds many do not understand their benefits
By Jane Sarasohn-Kahn Health plan illiteracy is alive and well, according to J.D. Power and Associates. The consumer market research firm's 2008 National Health Insurance Plan Study finds that one in two plan members don't understand their plan. In this...May 7, 2008 in Health Plans, Jane Sarasohn-Kahn | Permalink | Comments (6)
April 01, 2008
Practical Advice to Employers On Managing A Health Plan - Lynn Jennings
On blogs like this, people like me write analytically about issues which are often, at best, conceptual to us. Not so to the guys in the rough and tumble world of health care finance. I remember that the first time...April 1, 2008 in Health Plans | Permalink | Comments (2)
March 27, 2008
Rebuilding The Medical Home: What Walgreens Surely Sees
By Brian Klepper Though it probably went mostly unnoticed in the cacophony of health care stories, last week's news that Walgreen's had bought the two largest and most well-established worksite clinic firms, iTrax and Whole Health Management, was a harbinger...March 27, 2008 in Brian Klepper, Health 2.0, Health Plans, Physicians, The Industry | Permalink | Comments (10)
March 11, 2008
HEALTH PLANS: Time to cut a deal?
By Matthew Holt There's carnage amongst health insurer stocks on Wall Street this morning. For a long while I've been saying that the health insurer party was too good to last and in the past year things have certainly cooled...March 11, 2008 in Health Plans | Permalink | Comments (24)
March 07, 2008
HEALTH PLANS: Three Inconvenient Truths: The Future of Health Plans in a Connected World
By Matthew Holt In the same vein as Wyden’s speech to AHIP yesterday, this is the talk I gave to the Western Regional Conference (a group of Blues plans) on October 14, 2007. Hello my name is Matthew Holt and...March 7, 2008 in Health Plans | Permalink | Comments (25)
HEALTH PLANS: Ron Wyden on Health plans
By Matthew Holt Just for Friday, no Health 2.0 stuff. Instead two speeches, one by Oregon Senator Ron Wyden (D) last week to AHIP. The other from me to the Western Blues meeting late last year. This is Wyden's In...March 7, 2008 in Health Plans | Permalink | Comments (3)
February 23, 2008
HEALTH PLANS: $9 million? OK, We'll change our tune
On Thursday HealthNet was being sued by the LA City attorney's office and saying that it was doing nothing wrong and would keep on trucking: Health Net's Olson said the company's application had been approved by regulators and didn't need...February 23, 2008 in Health Plans | Permalink | Comments (9)
February 22, 2008
HEALTH PLANS: L.A. sues Healthnet
In the latest fall out over health plans behaving badly, the City of Los Angeles is suing Healthnet about its policy of paying bonuses to staff for cancellations. The suit alleges that Health Net sold at least 100,000 individuals policies...February 22, 2008 in Health Plans | Permalink | Comments (3)
February 14, 2008
HEALTH PLANS: I beat Lisa Girion!
This might be my proudest moment in blogging. Anyone can be ahead of the WSJ by 5 years. But on THCB I connected the dots between LA Times coverage of the dumb public relations of Wellpoint in California, and New...February 14, 2008 in Health Plans | Permalink | Comments (13)
February 13, 2008
HEALTH PLANS: Insurers getting lambasted
First, 24 hours after being shamed in the LA Times, Wellpoint has backed down on getting docs to check up on whether their patients should have their insurance recisionned (is that a word?). It’s good to know that someone’s setting...February 13, 2008 in Health Plans | Permalink | Comments (5)
February 12, 2008
HEALTH PLANS: Wellpoint can't leave bad enough alone
You’d think the folks at Blue Cross of California or in their parent corporation in Indianapolis would have heard of Lisa Girion of the LA Times by now. Do they really think that by compounding the PR disaster they had...February 12, 2008 in Health Plans | Permalink | Comments (8)
February 11, 2008
HEALTH PLANS: Who said this....?
In one of the many newsletters I diligently peruse so that you don't have to be contaminated directly I read this. Astonishing, even considering the source. I had a terrific opportunity to speak to 700 health insurance agents and brokers...February 11, 2008 in Health Plans | Permalink | Comments (8)
January 30, 2008
HEALTH PLANS: WellCare...killing health care some more?
After last Fall's FBI raid the top management at Wellcare resigned on Friday. The board is hoping that the new CEO, former United executive Charles Berg, will right the ship. After all who could we trust more than the WellCare...January 30, 2008 in Health Plans | Permalink | Comments (1)
January 22, 2008
HEALTH PLANS/HOSPITALS: Not a smart move
There's been a lot of discussion about a potential health care score a la FICO score. The right way to do this would be some way to reward providers/plans whomever for doing whatever it takes to improve a population's overall...January 22, 2008 in Health Plans | Permalink | Comments (3)
January 18, 2008
HEALTH PLANS: Brocade CEO goes to jail; what about McGuire?
I don't understand why the Brocade CEO is convicted of back-dating options for others and sentenced to jail while former United Healthgroup CEO Bill McGuire is somehow able to pay a small-ish fine relative to what he made and apparently...January 18, 2008 in Health Plans | Permalink | Comments (2)
January 16, 2008
Four Big Trends - Brian Klepper
Several events and trends emerged over the last year that will reverberate throughout the health care marketplace in 2008 and going forward. While none of these dominated the trade press like some other issues - electronic and personal health records,...January 16, 2008 in Brian Klepper, Health 2.0, Health Plans, Hospitals, Medicare Advantage, Patient Safety, Physician Rating, Physicians, Policy/Politics, The Industry | Permalink | Comments (8)
January 09, 2008
On Practical Reforms - Brian Klepper
Now that health care reform is once again an active, visible issue in state governments and the presidential campaigns, the ideas are flying fast and furious. Predictably, some ideas are better than others. Over at Health Care Policy and Marketplace...January 9, 2008 in Brian Klepper, Health 2.0, Health Plans, Physicians, Policy, Policy/Politics, Quality, The Industry, Transparency | Permalink | Comments (11)
January 03, 2008
The Politics of Publicly-Funded Health Care - Brian Klepper
Over at Health Care Policy and Marketplace Review, the always insightful Bob Laszewski walks us through the mechanics of the just-passed federal budget and its health care financing implications for SCHIP, physicians, hospitals, Medicare Advantage plans. This clear, common sense...January 3, 2008 in Brian Klepper, Health Plans, Hospitals, Physicians, Policy/Politics, The Industry | Permalink | Comments (1)
December 14, 2007
HEALTH PLANS: Populist Republican attacks sweet, innocent non-profit
Blue Shield of California, the cuddly non-profit, is going to the mat with the state over recissions. Essentially Shield is saying, “It was fraud, so the recissions are legal.” Everyone else has settled. This has mightly pissed off California insurance...December 14, 2007 in Health Plans | Permalink | Comments (11)
December 10, 2007
HEALTH PLANS: Bill McGuire--off the hook?
Bill McGuire Friday tried to put the options scandal behind him. Don’t forget that he did (at least) two very questionable things before the scandal came to light. First he formally abandoned utilization review at United in 2001. That to...December 10, 2007 in Health Plans | Permalink | Comments (0)
November 20, 2007
POLICY: Low prices ain't cheap enough
Mercer says that the number of small businesses offering health insurance to workers went down last year despite the greater and easier availability of high-deductible and HSA plans. Fewer small employers offered health insurance this year, despite the widespread availability...November 20, 2007 in Health Plans, Policy, Policy/Politics | Permalink | Comments (23)
November 09, 2007
HEALTH PLANS: Lisa Girion puts boot in again!
Will someone please stop that nasty Lisa Girion beating up sweet innocent health plans. Woodland Hills-based Health Net Inc. avoided paying $35.5 million in medical expenses by rescinding about 1,600 policies between 2000 and 2006. During that period, it paid...November 9, 2007 in Health Plans | Permalink | Comments (7)
November 07, 2007
HEALTH PLANS: I am dumb, dumb, dumb
I know what you're thinking but it's not that. Late last year I went back and forth with Bob at Health Policy and Marketplace Review on why, given the unlikely prospects for much growth in Medicare reimbursement and the Democrats'...November 7, 2007 in Health Plans | Permalink | Comments (1)
From Chatter, To Ideas, To Action: Humana’s Change Now 4 Health Campaign
You may be dubious that a big health insurer has much to add to the policy debate. But buried inside many of the giants are some interesting people indeed. Case in point Humana and its attempt to start an open...November 7, 2007 in Health Plans, Policy | Permalink | Comments (1)
October 30, 2007
HEALTH PLANS: Trading health plan stock rumors for fun & profit
Just when you thought stock action in health plans was all dull, along comes a little fun. Wellcare’s chart of course looks about as good as the average stock chart when the Feds raid. Whatever the company says, Wall Street...October 30, 2007 in Health Plans | Permalink | Comments (3)
October 19, 2007
HEALTH PLANS: Health Plans Behaving Badly
I spent Monday lecturing a bunch of health plans about their bad behavior and how that had to change or they’d eventually be put out of business. So how might that not play out? Here’s my best guess up at...October 19, 2007 in Health Plans, Policy | Permalink | Comments (4)
September 26, 2007
POLICY/HEALTH PLANS: Why Health Plans need to change their business model
A reporter called about the PNHP which is running single payer ads attacking Hillary, Barrack and John Edwards. Why are they doing it? Because they want to make sure those guys don't give into the insurers. Realistically there will be...September 26, 2007 in Health Plans, Policy | Permalink | Comments (8)
September 10, 2007
HEALTH PLANS/TECH: Selling out a name--et tu Harvard?
Over at HISTalk there's frequent criticism of "awards" that are handed out by analysts to vendors, and frequent assessment of which consultants can be trusted as independent, as opposed to which ones will "sell" an award. Frost and Sullivan gets...September 10, 2007 in Health Plans, Technology | Permalink | Comments (2)
August 31, 2007
BEST OF: Interview with Shawn Jenkins, CEO BenefitFocus
When I was contacted by the PR folks representing BenefitFocus I found out that they'd quietly put into place the original 1995 business plan of Healtheon--connecting employers and health plans electronically around enrollment and billing. (Remember The New New Thing?)...August 31, 2007 in Health 2.0, Health Plans, Podcasts, Technology | Permalink | Comments (1)
August 28, 2007
HEALTH PLANS: Who said this? No, really
But if you take five people who didn’t get coverage through their employer or were self-employed and you ask them, ‘What’s the No. 1 thing that keeps you awake at night?’ I think a large percentage would say health care....August 28, 2007 in Health Plans | Permalink | Comments (2)
August 16, 2007
A Broker Afterthought: An Acknowledgment, An Apology and A Criticism - Brian Klepper
In the comment section of my post on broker compensation, KWeller properly points out that 1) some states regulate broker commissions more stringently than Florida does and 2) I do a disservice to brokers who practice without financial conflict. He...August 16, 2007 in Brian Klepper, Health Plans, Policy, Policy/Politics, THCB, The Industry | Permalink | Comments (0)
Consultants to Hospitals: Prepare for Transparency - Brian Klepper
We must view and treat the community as the "owner" to whom we are fully accountable. Aggregate financial performance data, aggregate productivity performance and aggregate quality and patient satisfaction data belong in the public realm. How else can consumers make...August 16, 2007 in Brian Klepper, Health Plans, Hospitals, Physicians, Policy, Policy/Politics, Quality, The Industry | Permalink | Comments (4)
August 15, 2007
Managed Care Redux - by Brian Klepper
Like democracy, managed care is a great idea. It's just that its rarely been tried. Even so, my guess is that its about to re-emerge in a new, improved form, and possibly with some other name. If the signs around...August 15, 2007 in Brian Klepper, Health Plans, Hospitals, Physicians, Policy, Policy/Politics, Quality, THCB, The Industry | Permalink | Comments (7)
August 10, 2007
POLICY/HEALTH PLANS: The future of health plans
I had fun writing this piece on behalf of health plan CRM and Business Outsourcing company Connextions to help launch their new series of Thought Leadership Profiles. Some of the really rude stuff hit the cutting room floor, but given...August 10, 2007 in Health Plans, Policy | Permalink | Comments (8)
August 06, 2007
PODCAST/QUALITY/TECH/HEALTH PLANS: Disease management, technolgy and the future of health care--Gordon Norman tells all
Gordon Norman is Exec VP and Chief Science Officer at Alere Medical, formerly head of DM at Pacificare and a font of knowledge and opinion about disease management, technology, the role of health plans, and the chances for overall change...August 6, 2007 in Health Plans, Podcasts, Quality, Technology | Permalink | Comments (1)
August 03, 2007
POLICY/HEALTH PLANS: SCHIP passes the Senate, but I think for now Medicare Advantage is safe...for now
A version of SCHIP that doesn’t touch Medicare passed the Senate last night. It has a veto proof majority. Of course it now has to be reconciled with the house bill that raises more taxes and cuts Medicare Advantage. So...August 3, 2007 in Health Plans, Policy, Policy/Politics | Permalink | Comments (5)
August 02, 2007
HEALTH PLANS: SCHIP and Medicare Advantage by Maggie Mahar
You'll be seeing more and more of Maggie Mahar here as she works blogging into her new role at The Century Foundation. But of course, she's not the only one who's made this connection. If you want to see more...August 2, 2007 in Health Plans, Maggie Mahar, Medicare Advantage | Permalink | Comments (50)
July 31, 2007
HEALTH PLANS: Mega Life and Health -- Time to call AHIP, Goldman Sachs, Credit Suisse and BlackStone out
I spent a little time last year on the issue of Mega Life and Health. There's only one term for this company, and what's really frightening is that it's a major player in AHIP. If AHIP is ever going to...July 31, 2007 in Health Plans | Permalink | Comments (99)
July 30, 2007
HEALTH PLANS/HOSPITALS: Kaiser's tame blogger at it again
I think that most of the latest fines for Kaiser, which are only vaguely related to its original problems at the kidney transplant unit and are for poor performance of peer review and handling complaints at its hospitals are generally...July 30, 2007 in Health Plans, Hospitals | Permalink | Comments (2)
July 20, 2007
HEALTH PLANS/QUALITY: Klepper on the transparency conundrum
Over at The Doctor Weighs In Brian Klepper talks about the transparency conundrum. Should We Have Health Care Performance Transparency? By Whom? And How?. Should transparency be left in the hands of untrustworthy health plans with their own proprietary techniques?...July 20, 2007 in Health Plans, Quality | Permalink | Comments (0)
July 03, 2007
HEALTH PLANS: From the AHIP fields (Ignagni loves Shalala and vice versa--Newt's just watching!)
AHIP’s annual conference last week, and Karen Ignagni was recently spotted in USA Today slagging off Michael Moore as part of that newspaper’s “fair and balanced” look at the topic, and telling yet more lies about “Canadians coming to the...July 3, 2007 in Health Plans | Permalink | Comments (0)
July 02, 2007
POLICY/HEALTH PLAN: Karen Ignagni lie of the day
AHIP’s response to Sicko. Lined up in “cut to” style with answers but no questions so that it can be dropped into local news (check out the weird “B-roll” at the end). And again some of what she says is...July 2, 2007 in Health Plans, Policy | Permalink | Comments (3)
June 18, 2007
HEALTH PLANS/POLICY: Quinn rips Weintraub
Dan Weintraub who’s an interesting (and rare) right-wing journalist working in health care wrote a pretty dumb opinion piece in the Sacramento Bee last week saying that regulating health insurers was the wrong idea and wouldn’t work—because of course most...June 18, 2007 in Health Plans, Policy | Permalink | Comments (8)
June 14, 2007
POLICY/HEALTH PLANS: More communism at the Wall Street Journal
More radical Bolshevism at the Wall Street Journal. Venessa Furhmans is now saying that Health Savings Plans (are) Start(ing) to Falter. How dare she! She’s going to get it when Rupert takes over! On the other hand, just dumping people...June 14, 2007 in Health Plans, Policy | Permalink | Comments (9)
June 11, 2007
HEALTH PLANS: Looks like Bill McGuire and UNH are not out of the woods yet
A class action suit against the backdating of options has been allowed to proceed. CalPERS is the pushing the suit and the judge (not the plaintiff’s attorney) compared McGuire’s behavior to that of the con-artists in “The Sting.”June 11, 2007 in Health Plans | Permalink | Comments (0)
May 30, 2007
TECH/PODCAST: Interview with Bob Fisher, CEO of Foresight
Here's the transcript of the recent podcast with Bob Fisher from Foresight. The original interview is here and a 7 minute cut down version is up on Foresight's site too. Matthew Holt: This is Matthew Holt with the Health Care...May 30, 2007 in Health Plans, Technology | Permalink | TrackBack
May 16, 2007
POLICY/HEALTH PLANS: Marsha Gold, spoilsport communist!
At Health Affairs Mathmatica’s Marsha Gold takes a look at the expansion of Medicare PFFS plans. Those are the ones that our friends at AHIP are so keen on, because of all the benefits they bring to poor elderly seniors...May 16, 2007 in Health Plans, Policy | Permalink | Comments (1)
May 14, 2007
HEALTH PLANS: Blue Cross makes about-face on cancellations, with late afternoon UPDATE
Lisa Girion in the LA Times reports that one of the uglier pieces of health plan activities in recent years may be drawing to a close. Wellpoint’s Blue Cross of California unit has agreed that it will only rescind policies...May 14, 2007 in Health Plans | Permalink | Comments (4)
May 07, 2007
TECH/HEALTH PLANS: AthenaHealth causing trouble again
AthenaHealth caused a ruckus last year when it put out a ranking of how fast health plans were paying doctors. Now they're at it again. Cigna ranked No. 1 and United didn't do so well. Of course if just speed...May 7, 2007 in Health Plans, Technology | Permalink | Comments (5)
HEALTH PLANS/POLICY: Ignagni--arguing out of both sides of her mouth, with UPDATE
My favorite lobbyist has a letter in the NY Times. In which she argues that beneficiaries save money compared to regular Medicare, and (this is the fun part) if payments are reduced then this will have to be reflected in...May 7, 2007 in Health Plans, Policy/Politics | Permalink | Comments (0)
May 01, 2007
HEALTH PLANS: Last ditch defense of MA extra payments
I saw this letter in the NY Times from some NAACP types defending Medicare Advantage's advantages over Medicare FFS—the advantages being extra money from the taxpayer. I was going to comment but Bob Laszewski said it for me: The Health...May 1, 2007 in Health Plans | Permalink | Comments (0)
April 30, 2007
TECH/HEALTH PLANS: Interview/Podcast with Mark Ganz, CEO Regence and Luis Machuca, CEO Kryptiq
This is the transcript from an interview I did at WHCC last week with Mark Ganz, the CEO of Regence, the Oregon based Blues plan that operates in the Pacfic Northwest, and Luis Machuca, the CEO of Portland-based health IT...April 30, 2007 in Health Plans, Technology | Permalink | Comments (0)
April 18, 2007
Health Plans: Pulitzer for WSJ by John Irvine
The Wall Street Journal wins a Pulitzer Prize for public service reporting for the critical series it ran on irregularities in the way stock options are awarded at some American companies. The investigation triggered a backdating scandal implicating executives at...April 18, 2007 in Health Plans | Permalink | Comments (0)
April 06, 2007
HEALTH PLANS: At last the definitive reason to subsidize Medicare Advantage!
Paul Krugman's against it. At least I'm sure that what's Karen Ignagni, Grace-Marie Turner at al are thinking....April 6, 2007 in Health Plans | Permalink | Comments (0)
April 04, 2007
HEALTH PLANS/POLICY: Well we know who's side CMS is on!
CMS has decided that Medicare private plans are going to get higher rates this year despite the fact that many Congressional Democrats want to cut the rates they're paid. There’s been a healthy debate on THCB in the last few...April 4, 2007 in Health Plans, Policy | Permalink | Comments (2)
April 02, 2007
HEALTH PLANS/POLICY: Lawmakers Should Not Reduce Funds for Medicare Advantage Program, apparently (with quick UPDATE)
Who says so? Well it’s the BCBSA CEO. Lucky that’s not self -serving or anything. Perhaps he’d like to explain how his members and the other health plans valiantly stayed in the Medicare market last time, took huge losses but...April 2, 2007 in Health Plans, Policy | Permalink | Comments (11)
March 30, 2007
HEALTH PLANS: Bob Laszewski and me--right eventually?
Bob Laszewski and I have been continuing a dialog over whether Wall Street is smarter than us (obviously it's richer than us) in ignoring the risk to health plans from the potential cuts in Medicare Advantage proposed by virtually every...March 30, 2007 in Health Plans | Permalink | Comments (3)
PODCASTS/HEALTH PLANS/TECH: Interview with Stan Nowak, CEO of Silverlink
Here’s the transcript of my interview with Stan Nowak of Silverlink. The original audio is here. Matthew Holt: Hi, it's Mathew Holt of THCB and I'm back with another podcast. And this time I am talking with Stan Nowak, who...March 30, 2007 in Health Plans | Permalink | Comments (1)
March 29, 2007
POLICY/HEALTH PLANS: Has George changed his tune?
Found this Interview with KP CEO George Halvorson put out in January. Here he is talking about single payer PwC: Are there other practices you see overseas that you think are importable? George Halvorson: One of the nice things about...March 29, 2007 in Health Plans, Policy | Permalink | Comments (12)
March 28, 2007
PODCASTS/HEALTH PLANS/TECH: Interview with Stan Nowak, CEO of Silverlink
Stan Nowak is President and CEO of Silverlink which does automated phone calls on behalf of health plans. It's a lot more complex and much more interesting than you might think, and it really is closing the loop for those...March 28, 2007 in Health Plans, Podcasts, Technology | Permalink | Comments (0)
HEALTH PLANS/POLICY: Individual association problems
Nothing really new here, but a nice piece from Lisa Girion in the LA Times about how because of the haste of insurers to avoid association groups and insure the young healthies, said groups are going into death spirals. And...March 28, 2007 in Health Plans, Policy | Permalink | Comments (14)
March 27, 2007
HEALTH PLANS: KP's Halvorson talks--Merlin responds,and I comment
Things Halvorson said.... In his remarks to (video, no transcript yet) The Commonwealth Club as interviewed by Chris Rauber, who was being rather too nice—although that’s mostly the fault of the stupid written Q&A format the Commonwealth Club uses (You’d...March 27, 2007 in Health Plans | Permalink | Comments (3)
March 26, 2007
HEALTH PLANS/CONSUMERS/POLICY: Administrative costs--bad and will get worse with CDHPs
PNC Bank has a new survey out saying that 30% of all health care costs are to do with administration—actually it may be more than that if you believe the study in Health Affairs that said it was 20-22% of...March 26, 2007 in Consumers, Health Plans, Policy | Permalink | Comments (26)
POLICY/HEALTH PLANS: Clowns to the left of us, jokers to the right.....
Yet another study showing that even if you're insured, because of the structure of our insurance system even the insured have trouble paying bills. Now I know I should leave this well alone. It’s ground that I’ve trampled to death...March 26, 2007 in Health Plans, Policy | Permalink | Comments (7)
March 19, 2007
HEALTH PLANS/QUALITY: Setting up high performance networks leads to lots of trouble
Hmm…mistakes in health care data? Who’d have imagined that. Which leads to lots of politics in the setting up and creation of these “high-performing networks” and of course the ability for the baby of improvement to be thrown out with...March 19, 2007 in Health Plans, Quality | Permalink | Comments (0)
March 15, 2007
HEALTH PLANS: Guess who said this?
"Health insurers are committed to improving health care choices for small businesses and bringing costs under control for all Americans," A woman who’ll say anything in absolute opposition to the facts, so long as it makes her patrons look better....March 15, 2007 in Health Plans | Permalink | Comments (10)
March 14, 2007
CONUSMERS/HEALTH PLANS: 'Consumer-Driven Guy' Charged With Embezzling Millions in HSA Funds
Fraud and embezzlement by someone pushing HSAs? Who could possibly have imagined that type of character would be attracted to the business?March 14, 2007 in Consumers, Health Plans | Permalink | Comments (15)
March 12, 2007
HEALTH PLANS: UnitedHealth keeps gobbling
United is buying Sierra Health Services, a regional HMO in Nevada for $2.6 billion. Sierra is a more traditional HMO than most of the health plans United’s bought in recent years (Golden Rule et al). The price is a modest...March 12, 2007 in Health Plans | Permalink | Comments (10)
PODCAST/TECH: John Capobianco, President of Medecision "making the unknown known"
Here’s the transcript from interview with John Capobianco from Medecision talking mostly about the “payer-based health records” they’re developing with several big health plan customers, and distributing to providers. The audio podcast is here. Matthew Holt: Matthew Holt with The...March 12, 2007 in Health Plans, Podcasts, Technology | Permalink | Comments (1)
March 08, 2007
HEALTH PLANS/POLICY: Sierra-- a case study of needed insurance reforms
Now and again there’s a real world case that reminds you why the only solution for keeping private health plans is managed competition, with the emphasis on managed. Remember as you read this story that Alain Enthoven always said that...March 8, 2007 in Health Plans, Policy | Permalink | Comments (1)
March 06, 2007
PODCAST/CONSUMERS/TECH: HealthFacts
BCBS of Minnesota has set up an interesting approach to transparency and measuring provider performance. They've created a site called HealthCareFacts.org for consumers to look at and compare provider details, set up a subsidiary called Consumer Aware to run it,...March 6, 2007 in Consumers, Health Plans, Podcasts, Quality, Technology | Permalink | Comments (1)
February 28, 2007
POLICY/POLITICS: Will Medicare Advantage get slashed? with UPDATE
Bob Laszewski has been, correctly, all over the issue of Medicare Advantage payments and what the Dems will do to them. And he’s at it again CBO Pours Gasoline on the Democratic Plans to Cut Medicare Advantage Payments to HMOs....February 28, 2007 in Health Plans, Policy/Politics | Permalink | Comments (10)
TECH: Quick KP HealthConnect update
Of course the other big non-HIMSS tech news is that KP dumped interim CIO Phil Bruce Tukstra and brought in another outsider. While the LA Times says that Tukstra ran Health Connect, I’m not so sure. Andy Weisenthal told me...February 28, 2007 in Health Plans, Technology | Permalink | Comments (4)
LAT: Kaiser doc ordered fatal dose By John Irvine
The Los Angeles Times reports that police in Orange County and the Medical Board of California are investigating a Kaiser surgeon involved in the death of a patient under suspicious circumstances at Sierra Medical Center in San Louis Obisbo. Dr....February 28, 2007 in Health Plans | Permalink | Comments (0)
February 26, 2007
HEALTH PLANS: Glasscock names female successor at Wellpoint
Larry Glasscock at Wellpoint is stepping down this summer and has named a woman, Angela Braly, as his successor. Braly, 45, is an executive vice president, with responsibility for WellPoint's Medicare claims processing business, federal employees' health benefits business, and...February 26, 2007 in Health Plans | Permalink | Comments (2)
February 19, 2007
HEALTH PLANS: Shernoff files suit against Blue Shield
Los Angeles health care attorney William Shernoff filed a lawsuit on Friday seeking to block Blue Shield of California from retroactively canceling member policies after claims have been approved, a practice that critics allege is far more common in the...February 19, 2007 in Health Plans | Permalink | Comments (5)
February 16, 2007
HEALTH PLANS: Kaiser transplantation scandal-Will we ever know the truth?
Meanwhile, despite the fuss about the HealthConnect project--elsewhere the real Kaiser scandal may be whimpering out as the man behind it, Kaiser whistleblower David Merlin settled his lawsuit for unfair dismissal . I had a very frank conversation about the...February 16, 2007 in Health Plans | Permalink | Comments (4)
February 15, 2007
TECH/HEALTH PLANS: LA Times, day late and dollar short on Health Connect
Today's LA Times has a long story about Kaiser's Health Connect project. As far as I can tell it has no new information at all other than a quote from one pissed off employee who quit last week right at...February 15, 2007 in Health Plans, Technology | Permalink | Comments (2)
January 23, 2007
HEALTH PLANS: Does this sound in the least familiar?
From Government News of the Week:. Connecticut Attorney General Richard Blumenthal (D) said his office has received complaints that Assurant, Inc. denied claims based on questionable conclusions about patients' pre-existing conditions. The AG's office said it received 20 complaints against...January 23, 2007 in Health Plans | Permalink | Comments (10)
January 18, 2007
HEALTH PLANS/POLICY: Meter Reading--How Regulation Might Fail
Today I’m up at Spot-on in a piece about the influence of big health plans on reform efforts called Meter Reading: How Regulation Might Fail. Maybe, just maybe, we're getting serious about health care. This week's news says yet more...January 18, 2007 in Health Plans, Policy, Policy/Politics | Permalink | Comments (5)
January 12, 2007
POLICY/HEALTH PLANS: Wow, a loony libertarian unwittingly tells the truth on benefit mandates
In the mass of verbiage about the Schwarzenegger plan, you can find the odd interesting nugget. David Henderson from Hoover—writing in that bastion of reasoned clarity, the editorial section of the WSJ—admits that the impact of state mandated benefits on...January 12, 2007 in Health Plans, Policy | Permalink | Comments (14)
January 08, 2007
HEALTH PLANS/POLICY: And it's a right, and a left, and another right--I'm not sure he can take any more...
You’d think the LA Times’s Lisa Girion would have had the human decency to stop beating up the health insurance industry. It’s getting close to the time when the referee should step in to save the insurers from further punishment....January 8, 2007 in Health Plans, Policy | Permalink | Comments (20)
January 05, 2007
TECH/CONSUMERS/HEALTH PLANS: Not much employer backing for HSAs
Those of us who feel that the CDHP movement is largely being used as cover by employers for reducing the benefits (i.e. compensation) that they’re paying employees will not be too surprised by this new analysis. The source, Vimo, though...January 5, 2007 in Consumers, Health Plans, Technology | Permalink | Comments (4)
January 02, 2007
HEALTH PLANS/POLICY: Underwriting--pernicious and ridiculous
Lisa Girion in the LA Times kicks butt and takes names, exposing the individual insurance market for the fake gong-show that it is. She found a member of the LA insurance commission rejected by all three major health insurers in...January 2, 2007 in Health Plans, Policy | Permalink | Comments (18)
December 28, 2006
HEALTH PLANS: Wellpoint not out of the California woods yet
This Wellpoint policy retroactive cancellation story is not exactly going away -- Doctors seek to sue Blue CrossDecember 28, 2006 in Health Plans | Permalink | Comments (1)
December 21, 2006
HEALTH PLANS/TECH: Looks like the Deal's over--or is it?
So it looks like from Justen Deal’s website that he’s essentially going to be fired in absentia by Kaiser. My assumption is that he knew this was going to happen all along, and was essentially preparing the way for some...December 21, 2006 in Health Plans, Technology | Permalink | Comments (6)
December 14, 2006
HEALTH PLANS: Embarrased non-profit insurers still trying to hide the money
A long time ago (1993) in a universe far, far away pharma companies were somewhat concerned about public perceptions of their profits. Bob Leitman (long time at Harris, now at Greenfield) told me how, on a visit to a pharma...December 14, 2006 in Health Plans | Permalink | Comments (1)
HEALTH PLANS/TECH: PHRs--Can this woman ever tell the truth?
Time for the Karen Ignagni lie of the day. It comes in a session during which AHIP and the Blues talk about their sponsorship of a common model for PHRs (or at least for payer-based PHRs). It’s hard to know...December 14, 2006 in Health Plans, Technology | Permalink | Comments (4)
December 13, 2006
HEALTH PLANS/POLICY: Kaiser Permanente's plan to cover all Californians
The plan is interesting in that it seems to basically contradict the AHIP plan that Halvorson was touting last week. That one called for subsidies for low income workers to buy into private health plans. This one calls for a...December 13, 2006 in Health Plans, Policy | Permalink | Comments (3)
December 06, 2006
POLICY/POLITICS/HEALTH PLANS: Igleheart, Glasscock, pussycats
After a little prompting (i.e. 30 minutes after I posted a blog comment asking why it wasn’t up) Health Affairs has posted a letter I wrote two days ago in response to John Iglehart’s interview with Larry Glasscock in its...December 6, 2006 in Health Plans, Policy, Policy/Politics | Permalink | Comments (2)
December 04, 2006
HEALTH PLANS/POLICY: John Igleheart is a pussy
In a Conversation With Larry C. Glasscock, the CEO of Wellpoint, John Igleheart has either been massively restricted by Glasscock’s PR handlers or has revealed himself to be a complete pussy. A little history: having been a senior exec at...December 4, 2006 in Health Plans, Policy | Permalink | Comments (3)
December 01, 2006
POLICY/HEALTH PLANS: Yet more debatable data on CDHPs
HSC’s John Gabel (kind of a “neutral” in the debate) is out with a new study suggesting something that I think is true. The take up of CDHPs by workers offered them in a choice with other products (HMOs. PPOs)...December 1, 2006 in Health Plans, Policy | Permalink | Comments (4)
November 22, 2006
TECH/HEALTH PLANS/QUALITY: Lonny Reisman, Active Health Management transcript
Here’s the transcript from the podcast I did with Lonny Reisman, a week or so back. Really interesting stuff for those of you interested in the future of patient care management. Matthew Holt: So welcome to another forecast here at...November 22, 2006 in Health Plans, Quality, Technology | Permalink | Comments (5)
November 21, 2006
HEALTH PLANS/TECH: Full text of Andrew Wiesenthal (Permanente Federation) interview
Here's the full text of my interview from last week with Andrew Wiesenthal of the Permanente Federation--mostly about the HealthConnect project and attendant controversies! Matthew Holt: This is Matthew Holt at The Health Care Blog and tonight at rather short...November 21, 2006 in Health Plans, Technology | Permalink | Comments (2)
November 17, 2006
BLOGS/HEALTH PLANS: Why we love Roy Poses!
Over at Health Care Renewal Roy Poses notes that the Annals of Internal Medicine has an article by a little known Columbia University public health professor (well, actually not one, but you’d never know) with the name J. Rowe which...November 17, 2006 in Blogs, Health Plans | Permalink | Comments (1)
November 16, 2006
HOPSITALS/HEALTH PLANS: You'd think Kaiser's had enough bad publicity lately, but then again
The city of Los Angeles. is filing patient `dumping' charges against Kaiser Permanente. Obviously there are plenty of hospitals dumping patients onto LA’s Skid Row, and obviously the way our society deals with elderly people with dementia, (and younger ones...November 16, 2006 in Health Plans, Hospitals | Permalink | Comments (6)
November 15, 2006
TECH/HEALTH PLANS: Perhaps the last word on KP (for now at least)
Here’s a stack more comments on Kaiser HealthConnect at HISTalk (go down) and then Mr HISTalk’s conclusions, (again read down) which are very sensible and basically mirror mine! (surprise surprise!). As I said in comments over there and here—openness for...November 15, 2006 in Health Plans, Technology | Permalink | Comments (2)
November 14, 2006
TECH/HEALTH PLAN: HISTalk nabs Justen Deal
HISTalk has an interview with Justen Deal (of Kaiser Permanente although probably not for long, my guess)! It seems to me that we’re now coming down to degrees as to how to interpret the same facts. There isn’t too much...November 14, 2006 in Health Plans, Technology | Permalink | Comments (3)
HEALTH PLANS/POLICY: Would you buy a used health care policy solution from this association?
Here it is. AHIP’s Proposal — because they didn’t obviously didn’t get enough at the MMA trough in the last go around, they figure another $30 Billion a year for ten years will get us all the way to 95%...November 14, 2006 in Health Plans, Policy | Permalink | Comments (5)
November 13, 2006
TECH/HEALTH PLANS: Chris Rauber pokes more into KP
For those of you who can’t get enough, Chris Rauber, health care reporter from the SF Business Times has discovered that the investigations into the KP Kidney transplant fiasco are getting wider. And if anyone from KP wants to go...November 13, 2006 in Health Plans, Technology | Permalink | Comments (2)
TECH/HEALTH PLANS: more on KP
Well it’s coming thick and fast. First the podcast with Andrew Wiesenthal (previous post here). Then Gadlfy in her anti Kaiser site has some more about her take, including her commenters thinking that I’m just an apolgist being paid off...November 13, 2006 in Health Plans, Technology | Permalink | Comments (8)
TECH/HEALTH PLANS: A Permanente Group Executive speaks
There continues to be much flack in about the “email heard around the health care IT world” about Kaiser Permanente’s HealthConnect program and its success or lack or it, and its contribution or lack of it to a potential massive...November 13, 2006 in Health Plans | Permalink | Comments (4)
November 10, 2006
HEALTH PLANS: Legal cons abound in health insurance
(Hat tip to Don McCanne). Apparently being a scummy insurance company and selling not-quite-fraudulent policies to dumb consumers is all fine and dandy—or at least legal. This is not the first or last we’ve head of this type of thing—a...November 10, 2006 in Health Plans | Permalink | Comments (14)
November 09, 2006
HEALTH PLANS: Matthew Holt, stock trading pussy
Sector Wrap: Health Insurers Fall. UNH is down $5 or close to 10% from its high on Tuesday with Allen’s conecession in VA giving the Dems the Senate being probably the clincher today. And was I short, like I said...November 9, 2006 in Health Plans | Permalink | Comments (7)
HEALTH PLANS: A little more on KP
Here’s a piece from veteran SF Business Times health care reporter Chris Rauber on the Kaiser saga. I still basically stay where I was, but it’s worth noting that the presumed reason that Cliff Dodd resigned on such short notice...November 9, 2006 in Health Plans | Permalink | Comments (15)
PODCAST: Lonny Reisman of Active Health Management
Lonny Reisman is a physician who came up with what he believes is a way to improve medical care and patient outcomes by tracking data and feeding it back to practitioners in close to real time. Aetna liked the idea...November 9, 2006 in Health Plans, Podcasts | Permalink | Comments (2)
HEALTH PLANS: Are we finally at the top?
I was going to do a post election special, but Joe Paduda beat me to it over at Managed Care Matters. I was also going to short United Healthcare, given that the Dems win will likely make it rough on...November 9, 2006 in Health Plans | Permalink | Comments (0)
November 07, 2006
TECH/HEALTH PLANS: Gadfly tells me I'm MIA on Kaiser
Gadlfy has been telling me that I’m MIA on the big Kaiser story, but luckily MrHISTalk has picked up the slack and has printed the Internal E-Mail Criticizing Kaiser's HealthConnect Lands Employee in Hot Water. In addition in a presumably...November 7, 2006 in Health Plans, Technology | Permalink | Comments (4)
HOSPITALS/HEALTH PLANS: HCA and United---Someone blinked
After being at war in several markets for the past few months (Florida and Denver come to mind) HCA has agreed a national contract with UnitedHealthcare. United has been having member retention problems in N. California, meanwhile losing a major...November 7, 2006 in Health Plans, Hospitals | Permalink | Comments (2)
October 20, 2006
HEALTH PLANS/HOSPITALS: Maverick pulls hosptials out of HMOs
This medical maverick, (or that’s what the paper’s calling him) owns three hospitals in The OC (California) and has cancelled all his HMO contacts—going after Medicare patients and charging HMOs and PPOs full fare for those admitted via the ER...October 20, 2006 in Health Plans, Hospitals | Permalink | Comments (20)
October 18, 2006
HEALTH PLANS: Blue Cross Settling Patients' Lawsuits
Lisa Girion in the LA Times has had no small part in the story she reports today. Wellpoint’s Blue Cross unit is settling the patients' lawsuits against its rather nasty habit of widespread retroactive cancellations. The settlement cannot have been...October 18, 2006 in Health Plans | Permalink | Comments (1)
October 16, 2006
HEALTH PLANS: Wellpoint and United -- not much to be proud of...(with 12 noon EST UPDATE)
It is getting pretty difficult to find something nice to say about the nation's two largest health plans. Wellpoint's Blue Cross of California unit, already fined by the fairly tame CA Dept. of Managed Healthcare, is now being sued by...October 16, 2006 in Health Plans | Permalink | Comments (11)
October 10, 2006
POLICY/HEALTH PLANS: More evidence that HDHPs work, by Eric Novack
Eric Novack has something to say about HDHP/HSAs, even more to say about who’s getting rich as a result, and little to mention about self-selection. But then I’m just a cynic. >A simply fascinating report has come from Aetna recently....October 10, 2006 in Health Plans | Permalink | Comments (12)
October 06, 2006
HEALTH PLANS: Medicare Advantage--risk adjustment is the real key
John Caroll (a fellow “Fierce” editor, not that I’m one any more) gives private Medicare plans a rather soft ride and shows that appparently it’s all looking good for Managed Medicare! "The trajectory for managed care is very good," says...October 6, 2006 in Health Plans | Permalink | Comments (0)
October 03, 2006
HEALTH PLANS/POLICY: Emily Firedman rips the individual market a new one
Nothing that you haven’t already seen on THCB many time before, but in taking on (and slightly misrepresenting but not much!) the Mass concept that we should just tell all the uninsured to buy into the individual market, veteran commentator...October 3, 2006 in Health Plans, Policy, Policy/Politics | Permalink | Comments (9)
September 22, 2006
HEALTH PLANS: Blue Cross cancellation story rumbles on
With an election in less than 2 months, the state is finally wading into the Wellpoint BC cancellation mess. Blue Cross now faces a fine: In the first sanction of its kind, California's top HMO regulator fined Blue Cross on...September 22, 2006 in Health Plans | Permalink | Comments (7)
September 21, 2006
HEALTH PLANS: Wellpoint backs down?
Given that Blue Cross of California Unveils Major Initiative to Revise Rescission Policies and Procedures: in order to stop its retroactive cancellations, and that in its very own press release it quotes : William Shernoff, an attorney representing some customers...September 21, 2006 in Health Plans | Permalink | Comments (1)
September 20, 2006
TECH/HEALTH PLANS: Quick recap on PHRs and consumer health care
Yesterday I ran a panel at Teradata’s partner conference in MickeyMouseville, FL. On the panel were Liz Dudek from Medstat, Jill Burrington-Brown from AHIMA and David Cochran from Harvard Pilgrim health plan. Pretty interesting conversation. David is particularly fun and...September 20, 2006 in Health Plans, Technology | Permalink | Comments (6)
September 19, 2006
HEALTH PLANS: More of the same bad behavior?
This article, Sick but Insured? Think Again by Lisa Girion at the Los Angeles Times is why she’s been slow to respond to my email about the AHIP quote from last week. No matter. It’s the same meme about California...September 19, 2006 in Health Plans | Permalink | Comments (3)
HEALTH PLANS/PBMs: Employers are dumb and therefore get punked
I couldn’t write about this yesterday because I spent the day hanging out in airports, but plenty of people emailed me about Barbara Martinez of the WSJ and her continued journey into the seemy side of employer benefits. As I’ve...September 19, 2006 in Health Plans, PBMs | Permalink | Comments (5)
September 18, 2006
HEALTH PLANS: Is medical cost trend headed down again?
Aetna seems to think so. Last week Aetna shares rose after comments on medical costs. Of course this could be a blip given that last quarter the stock fell on a higher than expected medical loss ratio. But assuming that...September 18, 2006 in Health Plans | Permalink | Comments (5)
September 15, 2006
HEALTH PLANS: The individual insurance market sucks; did I just catch AHIP in yet another lie?
You’re not exactly surprised are you? A Commonwealth Fund Study Says Individual Insurance Too Costly The overwhelming majority — 89% — of working-age adults who shopped for health coverage in the individual market over the last three years were rejected...September 15, 2006 in Health Plans | Permalink | Comments (14)
September 11, 2006
HEALTH PLANS: Wellpoint/Anthem branding mystery
Tom Leith is perplexed about the nation's largest health plan’s branding strategy: Have you noticed Anthem is re-branding some/most/all of its Wellpoint operations as "Anthem"? Look at all the "Anthem BCBSs" you see popping up. Is it because Wellpoint destroyed...September 11, 2006 in Health Plans | Permalink | Comments (10)
PHARMA/HEALTH PLANS: Responding to propaganda with idiot propaganda
Michael Moore dissects U.S. health care. So the first excerpts of "Sicko" have been shown, and the spin from the industry is already quite remarkable. We can't control what a major Hollywood entertainer does," said Mohit Ghose, a spokesman for...September 11, 2006 in Health Plans, Pharma | Permalink | Comments (7)
September 01, 2006
HEALTH PLANS/POLICY: A health plan CEO who genuinely believes in universal coverage
Health Plan CEO Georganne Chapin believes managed care can evolve with universal coverage! I thought her money quote was pretty amusing. So then, if Americans are interested in universal coverage, the industry supports it, and the money is already in...September 1, 2006 in Health Plans, Policy | Permalink | Comments (118)
August 28, 2006
HEALTH PLANS/QUALITY: BC California on P4P
My erstwhile colleagues at FierceHealthcare have an interview up with Dr. Michael Belman, staff VP and Medical Director, Blue Cross of California. It's a pretty good introduction, for those of you who don't know much about it, to the P4P...August 28, 2006 in Health Plans, Quality | Permalink | Comments (0)
August 25, 2006
INTERNATIONAL: Maybe privatization in the UK will not be quite so swift
Strike one for the little guy. A pensioner (that’s a “senior” to us Yanks) has won a court battle to stop a US healthcare giant from taking over a GP practice. The giant in question is United HealthGroup which apparently...August 25, 2006 in Health Plans, International | Permalink | Comments (1)