The Need to Require Docs to Follow Evidence Based Medicine Practices

From Reuters:

Even when following medical guidelines to the letter, doctors often use treatments that have little or no scientific support, U.S. researchers said Monday. They found only one in seven treatment recommendations from the Infectious Diseases Society of America (IDSA) -- a society representing healthcare providers and researchers across the country -- were based on high-quality data from clinical trials.

Moody's: 2011 Outlook Bleak for Health Insurers

It will be harder for HIs to be profitable:

http://www.modernhealthcare.com/article/20110104/NEWS/301049965/0#

ACA Changes Forthcoming in 2011

Here is a list of what to expect:

• Reports to Congress: the National Quality Strategy, National Prevention Strategies from the U.S. Department of Health and Human Services (HHS)
• Establishment of the CMS Center for Innovation
• Implementation of insurance plan requirements: medical loss ratio (MLR), premium increase oversight, and others
• Start of Medicare bonuses to primary care providers and general surgeons who treat under-served populations; equivalent pay to certified nurse practitioners for primary care services
• Prohibitions against preventive services cost sharing start for Medicare enrollees
• New employer W-2 reporting (1099 provision)
• Enhanced Medicaid home and community-based services funding for states
• Start of the annual pharmaceutical manufacturer excise tax ($2.5 billion per year)
• Discounts for branded prescription drugs in Part D coverage begin for Medicare enrollees
• New disclosure requirements for ownership of skilled nursing and nursing homes
• Initiation of nutrition labeling on menus and vending machines
• Enhancement of government websites: Healthcare.gov (for insurance), Physician Compare, and others
• First working sessions for the Patient Centered Outcome Research Institute (PCORI) (members already named and recruitment for an Executive Director is underway)

Growth in Medicaid Managed Care Will Be in the South

Here is a good-follow-up to my most recent post about opportunities for Medicaid managed care growth:

http://www.aishealth.com/Bnow/hbd010511.html

Good Summary on Changes to Medicaid

Due to the ACA, Medicaid enrollment is really going to jump. This is why I think any managed care organization should look into offering a managed care program for this population though the low profit margin could make it unattractive for small organizations.

http://www.bcbsm.com/healthreform/reform-alerts/ra_01_04_2011.shtml

Study in Texas Shows Health Insurance Hoops Save Money

A study from Health Affairs comparing Medicare costs in two Texas towns to those of private pay patients showed that health insurers actually save money. Why?

Among the tactics used by BCBS that might not be employed by Medicare, according to Franzini, are preauthorizations, provider utilization monitoring, case management efforts and stepped up prevention and wellness programs and incentives. In other words, meddling in provider (and patient) decision-making is effective … at least in some cases.

Chalk one up for health plans and their contentious rules which require physicians to clear procedures and medications before they are delivered.

http://www.healthleadersmedia.com/page-2/HEP-260971/Health-Plans-Data-Proves-that-Meddling-Works

Regulations Due for ACOs at the End of January

This is an excellent article on the issues in starting up an ACO, particularly the upfront costs which can be high given reporting and IT requirements:

http://www.healthleadersmedia.com/page-1/LED-260798/How-to-Finance-and-Build-Your-ACO