cmonfils | February 8, 2012
We previously posted regarding Michigan’s Paid Claims Assessment Act (the “Act”) which assesses carriers a 1% surcharge on paid health claims. The Act defines carriers to include group health plan sponsors, along with insurance companies and also assesses third party administrators. Thus, it is likely that group health plan sponsors will end up either paying the cost themselves or having it passed onto them by their insurance company or third party administrator.
Category: ERISA, Michigan, Preemption |
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cmonfils | February 8, 2012
Two important cases provide good reminders to plan fiduciaries about (1) the importance of documentation of fiduciary processes, and (2) accurate communication of plan design changes to participants and beneficiaries.
Category: Fiduciary, Plan Documents |
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cmonfils | February 8, 2012
As the Supreme Court prepares to hear legal challenges to the health reform law in March, most Americans expect the Justices to base their ruling on their own ideological views rather than their interpretation of the law, according to the January Health Tracking Poll. Other key findings include:
Category: Health Care Legislation, Supreme Court |
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cmonfils | February 8, 2012
Last August, under authority granted by Obama- care, Secretary of Health and Human Services Kathleen Sebelius published an “interim final rule” for comment that would require private health-insurance plans to cover, as “preventive services,” all FDA-approved “sterilization procedures” and “contraceptive methods” — and without deductibles or co-pays. We and other critics raised numerous objections, none of which was addressed last Friday, when Sebelius announced the final promulgation of the rule, which will go into effect Aug. 1.
Category: Health Care Legislation, Health Insurance, HHS |
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cmonfils | February 8, 2012
January 24, 2012 (PLANSPONSOR.com) – Oregon’s Public Employees’ Benefit Board (PEBB) voted to give $155,000 to the Oregon Public Health Division to help fund its Wellness@Work program.
Category: Oregon, Wellness |
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cmonfils | February 8, 2012
Chuck Weller, Cleveland–As a health care old timer who lived with the HMO Act of 1973 and a lawyer, ACOs seem much like HMOs under another name and will not succeed as much as the country needs for many of the same reasons. Eg, state regulation of insurance cripples interstate innovation and competition (the US is the only major country in the world that bars national insurance competition in effect creating state insurer and HMO monopolies), capitation and provider risk theory vs the complexity of patients having vastly different health status, lobbyists that understandably protect their clients and undermine needed innovation, and more.
The best hope for ACOs and Medicare/Medicaid reform generally is a two step process that taps what everybody in health care knows from Dr Wennberg’s work on variations is on the order of $750 billion annual savings. The first step avoids lobbyists and government having to devise enormously complex and ever changing payment innovations. The first step takes advantage of a legal opportunity many don’t know and is not just theory, as it resulted in what the CBO reported was “the slowest rate of growth in over 30 years” in public and private health benefit costs in the early 1990s. The first step is to have a few self-insured employer and union plans adopt Michael Porter and Elizabeth Teisberg’s idea of paying providers as a team by disease, what I call “Patient Value Organzaiations.” As legal matter, that is not insurance and thus payment innovation (excluding capitation) is not regulated by 50 states. There are 110 million people with self-insured benefits, and success at one employer or union plan triggers adoption by others at great speed. The second step is for government programs to adopt the new creations, PVOs. Think horse and buggies in 1890–that’s our health care system now. Let the first step of innovation begin–so we all can be in jet planes soon.
Category: Accountable Care Organizations |
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cmonfils | February 8, 2012
It’s often said that the main method of paying health-care providers—with a fee for each service—results in increased and wasteful spending. Such a system, its critics say, rewards providers just for doing more procedures, rather than for providing efficient and high-quality care.
http://online.wsj.com/article/SB10001424052970204720204577128901714576054.html?KEYWORDS=ANNA+WILDE+MATHEWS
Category: Accountable Care Organizations, Health Insurance |
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