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September 29, 2009     Spotlight  Medicare Advantage plans need to prepare now for expected changes The health insurance industry is carefully monitoring how the various options on the table for enacting health care reform will affect their business. Regardless of exactly which provisions are included in any potential legislation, it appears that Medicare Advantage (MA) plans will face a drastically different payment landscape. Preparing for changes now will allow payers to better understand what challenges they may face and formulate strategies for managing the various scenarios, according to Stephen Wood, senior vice president, Ingenix Consulting. "There is no question that regardless of the shape overall health care reform legislation takes, there will be changes to the MA program," Wood said. "That train has left the station. Plans have to be very proactive in responding to the predicted changes." Click here to continue reading this article online.     Employers  Comparative effectiveness research, medical homes have employer support Employers stand behind two ideas in the health care reform debate: comparative effectiveness research, which studies which treatments are the most effective, and the medical home model, which emphasizes prevention and management of chronic health issues. With effective use of CER, employers "will be paying for things that work, which improve life, and we won't pay for things that don't work," said the president of the National Business Group on Health. Workforce Management Online (9/2009) Employers add patient advocacy to benefit offerings Employers are increasingly using patient advocates -- professionals who can help patients with everything from dealing with insurance claims to understanding treatment options -- to help workers answer questions and solve problems related to their health care. The New York Times (9/11) Improving worker health means balancing wellness, disease management Carefully balancing wellness programs with disease management is an important way to get the most out of investments in health care, according to experts. Employers "really got the message that if you want to control costs in any way, you've got to keep people healthier," said National Business Group on Health President Helen Darling. Business Insurance (9/13) Companies pump funding into on-site exercise facilities McKee Foods Corp., Unum Group, BlueCross BlueShield of Tennessee and the Tennessee Valley Authority have invested in the health of their workforces and offer employees opportunities to exercise through a range of facilities including on-site fitness centers, outdoor trails and swimming pools. Chattanooga Times Free Press (Tenn.) (9/13) Experts advise employers to be flexible if there is a swine flu outbreak Experts say companies should prepare to be flexible with employees' schedules in case the U.S. experiences a swine flu outbreak. It will be especially important to allow workers paid sick leave if they need to care for family members and to forgo requiring a doctor's note. Google/The Associated Press (9/9) Solutions: For Employers |  Health & Productivity Optimization |  Decision Support |  Health Benefits Consulting   Hospitals  More facilities cut costs with "manufacturing mindset" A "manufacturing mindset" helps hospitals reduce costs in supply management and employee turnover, among other areas. "If you do the right thing the first time around, you'll reduce the cost of health care," said a University of Kansas Hospital executive. The Kansas City Star (Mo.) (9/14) Voice technologies streamline work at hospitals Butler Memorial Hospital and The Cleveland Clinic's Fairview Hospital use voice technologies to help staff work more efficiently. The technology can record information and add it to patients' electronic medical records. It also frees up nurses' hands and allows them to work on the go. InformationWeek (9/17) Maryland hospitals volunteer for epidemic surveillance system The 46 acute-care hospitals in Maryland have volunteered to help the state stay up to date on public health concerns by participating in the Electronic Surveillance System for the Early Notification of Community-based Epidemics. "Keeping track of the symptoms, the chief complaints of patients, has been shown over time to be a fairly reliable indicator of outbreaks taking place in a community," a state official said. Government Health IT (9/15) Going low-tech to cut back on medical errors works for Sacramento hospitals Hospitals in the Sacramento area realize the virtue of simple, low-tech strategies to reduce medical errors. For example, color coding socks helped one facility cut back on patient falls. "A computer will allow you to make a mistake faster and with greater magnitude than a paper system," said one expert on hospital safety. The Sacramento Bee (Calif.) (free registration) (9/14) Pediatric oncology patients get canine visitors at Illinois hospital Advocate Lutheran General Children's Hospital's pediatric oncology unit invites dogs participating in the Canine Therapy Corps and Dogs from Rainbow Animal Assisted Therapy to keep patients and their families company and entertain them. Niles Herald-Spectator (Ill.) (9/10) Solutions: For Hospitals |  Health Care EDI |  Coding & Reimbursement |  Performance Analysis |  Operational Improvement   Payers  Communicating with members in clearer language Health insurers are taking steps to improve communication by using language that patients can better understand. "We took out all 'insurancespeak' and 'CIGNAspeak,'" a Cigna official said. Aetna and Kaiser Permanente are also focusing on making member communications clearer. Los Angeles Times/Kaiser Health News (9/21) Payers adopt different strategies to encourage mail ordering Some payers are seeking increased participation in mail-order fulfillment among their members. UnitedHealth Group subsidiary Prescription Solutions reaches out to new members with a welcome package about the service that outlines the benefits it provides. Atlantic Information Services/Drug Benefit News (9/18) Company Web sites focus more on customer engagement More individuals find their own health insurance policies through the Internet, presenting an opportunity for payers to use their Web sites to advertise such products. "We're now seeing an evolution of health plan Web sites," said one expert. "They're moving from customer service to more customer engagement." Atlantic Information Services/Health Plan Week (9/4) Benefit design plays role in controlling use of specialty drugs, report finds Appropriately designing benefits packages can go a long way toward controlling the use of specialty drugs, a new report finds. "Benefit design should be appropriate to drive adherence and manage medical costs that could be incurred" due to noncompliance, said an executive with the pharmacy benefit manager that released the report, Prime Therapeutics LLC. Atlantic Information Services/Specialty Pharmacy News (9/17) Telehealth gets boost from accepting health insurers United Healthcare recently demonstrated to elementary students how its telehealth network functions. Payers increasingly accept virtual health care and are more willing to pay for it. "More and more companies are seeing the benefits of telehealth," noted an expert from the Center for Telehealth and E-Health Law. The Sun (Baltimore) (9/14) Solutions: For Payers |  Care & Health Management |  Network & Credentialing |  Payment Integrity |  Consumer Tools |  Underwriting & Actuarial |  Health Care EDI |  Decision Support |  Claims Reimbursement   Pharma  PhRMA invests in advertisements supporting health care overhaul The Pharmaceutical Research and Manufacturers of America is funding advertisements in support of health care reform plans submitted by Sen. Max Baucus, D-Mont. The trade group allocated $150 million this summer to pay for advertisements backing reform. The New York Times (9/12) GSK makes access to free drug program application process easier GlaxoSmithKline is changing its free drug program to make it easier for people with financial hardships to gain access to free medications. Patients can now apply for the company program without a middleman such as a pharmacist or nurse. Triangle Business Journal (Raleigh/Durham, N.C.) (9/16) New drug research kits could lead to better discoveries New kits aim to help drug researchers improve results and discoveries. "It will very likely lead to the development of some novel therapeutics," said the founder of Blue Sky Biotech, which partnered with Protein Attachment Technologies LLC to launch the kits. Worcester Business Journal (Mass.) (9/14) Partnership formed to create vaccines for developing world Merck & Co. has partnered with the Wellcome Trust to create MSD Wellcome Trust Hilleman Laboratories, an India-based, 60-person company that will work on effective and affordable vaccines for developing countries. Financial Times (tiered subscription model) (9/17) Discovery could lead to new treatments for mucus in the lung Chronic lung disease patients -- and perhaps even those suffering from the common cold -- may have help on the way from a genetic breakthrough. Researchers hope the discovery that a gene, SPDEF, has a key function in the production of mucus will lead to new potential treatments. BBC (9/14) Solutions: For Pharma |  Therapeutically-Specialized Research |  Drug Safety |  Research Staffing |  Health Economics & Outcomes |  Clinical Data Services   Physicians  NEJM survey finds U.S. doctors support insurance coverage expansion A recent New England Journal of Medicine poll of U.S. doctors showed that most respondents support a "public option" in addition to private health insurance. "It's clear that the majority of U.S. physicians support both public and private options to expand coverage," the journal said. Yahoo!/Agence France-Presse (9/14) Expert says HIEs can make life easier for physicians using EHRs Health information networks could benefit physicians who are worried about the required reporting for electronic health records, an HIE executive said. "We can aggregate the data. We can do the reporting for them. We can send the standard transactions. That means not having to replace systems or upgrade systems if they can make a direct connection to an HIE," she said. Government Health IT (9/18) HHS to distribute grants for projects on reducing malpractice suits The Department of Health and Human Services plans to provide grants totaling $25 million for demonstration projects on ways to reduce "frivolous lawsuits" targeting U.S. physicians. "Many doctors report that they practice costly defensive medicine because they are fearful of lawsuits," said the HHS secretary. Bloomberg (9/17) Seeing several patients at once serves doctors well Some patients at Parkland Health Center have their medical appointments in groups and respond favorably to the new system. "You get to learn what other people are going through and if you have the same problem, then you kind of already know 'cause they talked about it here," said one patient. Others said the group appointments are more convenient because they cut out time spent in the waiting room. NBC.com (9/16) Gastroenterologist celebrates 100th birthday and keeps working Dr. Joseph Kirsner, a 100-year-old gastroenterologist, is continuing his career as a University of Chicago professor. Before becoming the Louis Block Distinguished Service Professor of Medicine at the university, he treated patients, trained other doctors and wrote hundreds of scientific papers. Chicago Sun-Times (9/21) Solutions: For Physicians  |  Health Care EDI |  Revenue Cycle Optimization |  Coding & Reimbursement |  Operational Improvement   Public Sector  National network could help stop virus transmission from organ transplants The Centers for Disease Control and Prevention has been working on a national organ and tissue transplantation network that could help prevent virus and disease transmission through transplants. "It could potentially result in fewer transmission events, incidents of disease and death," said a CDC notice. Government Health IT (9/22) New York City has new public health plan New York City's health commissioner is taking aim at smoking, hospitalizations and sugary beverages with his recently announced health agenda, Take Care New York 2012. "Is this agenda realistic? You never know until you try," said the health commissioner, Dr. Thomas Farley. Crain's New York Business (9/14) Maryland leads the way in launching a statewide HIE A health information exchange across the state of Maryland may be at the forefront of HIEs in the country. The Maryland network, called the Chesapeake Regional Information System for Our Patients, CRISP, could be operational before a national one comes online. The Sun (Baltimore) (9/18) CDC takes on colorectal cancer screening in 22 states The Centers for Disease Control and Prevention funded a number of states' and tribal organizations' colorectal cancer screening programs with the "ambitious but realistic" goal of having "80% of the age 50-plus population screened by the end of five years in the respective states and tribal associations," said the medical director of the CDC's colorectal cancer screening program. Medscape (free registration) (9/15) States join hospitals, Web sites in providing price information for medical procedures States, hospitals and individual Web sites are doing more to help patients compare costs for medical procedures so patients can shop for the best prices and be prepared for medical bills before they arrive. "If consumers want to know what the cost of something is going to be, we should be able to give them an answer," said an official with Bellin Health System. CNN (9/10) Solutions: For Public Sector |  Claims Overpayment Prevention |  Care & Health Management |  Coding & Reimbursement   Workers' Compensation & Auto Liability  Hawaii boasts drop in workers' compensation loss costs Fewer workers' compensation claims have led to a 4.1% drop in loss costs in Hawaii. "This is the largest workers' compensation insurance rate decline of any state in the nation, except possibly those states that have enacted major statutory reforms," said Hawaii's insurance commissioner. American City Business Journals/Honolulu (9/10) Oregon workers' comp insurance costs down again in 2010 For the fourth year in a row, the cost of workers' compensation insurance in Oregon will decrease in 2010. "We are fortunate in Oregon to have a strong workers' compensation system that keeps costs low for employers while continuously improving benefits and outcomes for workers," said the state's governor. Portland Business Journal (Ore.) (9/11) Maine workers' comp insurer to pay customers $10 million in dividends MEMIC, a workers' compensation insurance company based in Maine, will pay $10 million in dividends to its customers in November. "This dividend is reflective of both the performance of our policyholders in reducing injuries and of the responsible management of our company," said MEMIC's president and CEO. MaineToday.com/Portland Press Herald (9/23) Lower loss costs lead to workers' comp rate drop for KEMI customers Kentucky Employers' Mutual Insurance, the state's biggest provider of workers' compensation insurance, is dropping its rates an average of 6% starting Oct. 1 for new policies and renewals because of lower loss costs. American City Business Journals/Louisville, Ky. (9/21) Safety experts call for clear expectations about Internet use while driving Safety experts are questioning some states' practice of offering traffic or road-condition tweets while also enforcing bans on text messaging for drivers. "You shouldn't be fiddling around with any kind electronic gadget in your car while driving," said a politician from Minnesota. ABC News/The Associated Press (9/18) Solutions: For Workers Comp & Auto Liability |  Claims Cost Management |  Data Benchmarking & Pricing |  Health Care EDI   SmartQuote  We can draw lessons from the past, but we cannot live in it." --Lyndon B. Johnson, 36th U.S. president Subscriber Tools       Web version |  Search past news |  Archive |  Privacy policy   About Ingenix Ingenix unites the brightest minds to transform organizations and improve health care through information and technology. We partner with more than 250,000 clients worldwide to solve the most important problems in health care. Learn more at ingenix.com.       Recent Ingenix Innovations Issues: Thursday, September 17, 2009 Tuesday, September 01, 2009 Tuesday, August 25, 2009 Thursday, August 06, 2009 Tuesday, July 21, 2009     Lead Editor:  Elizabeth Collins       Distributed by: SmartBrief, Inc.®, 1100 H ST NW, Suite 1000, Washington, DC 20005     © 1999-2009 SmartBrief, Inc.® Legal Information