ACO Risk Might be too Great for Some

With risk comes great reward and also potential losses:

http://www.healthleadersmedia.com/content/PHY-266033/ACO-Hurdles-Risks-Could-Dampen-Provider-Enthusiasm

Aetna to Reduce Individual Premiums in CT

I am fairly surprised to write the above headline. This certainly was a possibility because of the new MLR requirements under the ACA but it is still hard to believe. Rates will drop anywhere from 5 to 19.5 percent with 10 percent being the average come September 1st.

http://www.ctmirror.org/story/12550/aetna-seeks-cut-health-insurance-rates

The Challenges of the CA Health Exchange

There are many given the size of the state and its horrible fiscal condition. But it is pressing on while my home state sits on its hands and waits for the federal ruling on the legality of the individual mandate:

http://www.kaiserhealthnews.org/Stories/2011/May/10/california-health-care-exchange.aspx

VT Gov Ready to Sign Single Payer Bill

Funding/financing still need to be worked out but the VT BCBS Plan is behind this which is a very positive sign. This could be the model for other states. But it is amazing to think that while 26 states have brought suit against the ACA one state is going with the public option.

http://www.commonwealthfund.org/Content/Newsletters/Washington-Health-Policy-in-Review/2011/May/May-9-2011/Vermont-Governor-Ready-to-Sign-Universal-Health-Care-Bill.aspx

The NAIC and the ACA MLR Calculation

Where should broker commissions reside? On the MLR side or the admin one?

http://www.kaiserhealthnews.org/Columns/2011/May/051011naicconsumerreps.aspx

It's Tough Being a Health Care Plan PR Employee

Is their any industry that catches more flack than health insurance? Perhaps oil companies when the price of gasoline inexplicably rises. Here is more:

http://aishealth.com/archive/nhpw042511-02

How to Control the Cost of Health Care

Without a doubt HC costs are high because providers are paid for what they do, not how effective the treatment is. Actually in some cases providers generate more revenue when they screw up and a patient has to be readmitted to a hospital. So what can be done differently? Paying for Outcomes:

Paying for Outcomes means encouraging hospitals, physicians and other provider groups to reduce potentially preventable events -- PPEs -- that harm patients and add costs. In other words, the approach rewards health care organizations that provide high-quality, effective care, and dings providers that deliver lower quality, less effective care.

There are five major types of PPEs – readmissions, admissions, complications such as infections, ER visits that lead to an inpatient admission, and outpatient procedures such as unnecessary imaging tests. The health law moves in the P-4-O direction by targeting hospitals with high rates of potentially preventable hospital readmissions. Beginning in 2012, these hospitals will need to adjust the quality of medicine.

http://www.kaiserhealthnews.org/Columns/2011/May/050911mcdonough.aspx