Contributor: Jane Dubose
Topic: Quality, NCQA, population health management

There was a lot of positive news around health plan quality improvements from a webinar recently sponsored by the National Committee on Quality Assurance. Obesity screenings for adults and children are increasing, and largely because of the Star rating program in Medicare, the quality of care delivered to seniors through Medicare Advantage plans is also dramatically going up.

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Contributor: Lyda Phillips
Topic: Exchanges, Medicaid, Utah

Ascension Health, the largest Catholic health system in the United States, better watch its back.

Trinity Health and Catholic Health East are coming together, and when (or if) the deal is done, the new system will sprawl across 21 states with 82 hospitals and more than 87,000 employees, including 4,100 employed physicians. Combined, the new system would generate annual operating revenue of about $13.3 billion.

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Contributor: Mark Cherry
Topic: Medicare, Star ratings, Florida

 The star ratings for 2013 Medicare Advantage plans came out last Friday, which for some of us at HealthLeaders-InterStudy is the equivalent of the release of the BCS College Football rankings.  My colleague Joel, an expert on MA thanks to his years in the trenches at Humana, peeked over at my cubicle with an exciting tidbit:

“Did you see that Humana’s Medicare plan in Florida got 4.5 stars?”

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Contributor: Paula Wade
Topic: Medicare, Medicare Advantage, drug adherence, Star ratings

If there’s one thing that doctors, pharmacists, health plans and drug companies all agree on, it’s that the health system needs to do more to keep patients compliant on their prescribed medications – particularly those that prevent serious and expensive health complications of chronic illness.

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Contributor: Bill Melville
Topic: Mergers, Blue Cross Blue Shield, Pharmacy Benefit Managers

Health Care Service Corp. doesn’t grow haphazardly. In fact, the nation’s fourth-largest insurer adds new nonprofit Blue Cross and Blue Shield plans at a snail’s pace compared to for-profit insurance competitors.

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Contributor: Chris Silva
Topic: Integrated Delivery Systems, mergers, hospitals, Pennsylvania

West Penn Allegheny Health System’s divorce from Highmark may not be final, despite borderline incendiary statements from both parties suggesting a wide rift exists.

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Contributor: Bill Melville
Topic: Medicaid, states

The Affordable Care Act is headed for another showdown – and this time, it’s local. In several states where governors are declining Medicaid expansion, safety-net providers have discussed pursuing Medicaid expansion on a regional level.

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Contributor: Sheri Sellmeyer
Topic: IDNs, HMOs, hospitals, physicians

A big question these days in healthcare is whether there will be a role for traditional health insurers as hospitals and physician groups gear up to take on risk. Perhaps not, if more go the route of Sutter Health in California, which announced this month that it is applying for a license to run an HMO.

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Contributor: Jane DuBose
Topic: ACA, State Exchanges, Presidential Election, Tort Reform

Just a few floors above the craps and Roulette tables in Las Vegas, economists, political commentators, health plan executives and others speaking at the 2012 Managed Markets Summit were placing safe bets on at least one big thing: the spending spree in healthcare can’t be sustained.
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Contributor: Lyda Phillips
Topic: Blue Cross Blue Shield, Michigan, rate regulation, state exchanges

It was inevitable. It’s been discussed since passage of the Affordable Care Act in 2010. The Supreme Court’s decision upholding the ACA just amped up the urgency.

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