Managed Care e-News
Jan. 1, 2013

Hospitals demand payment upfront from repeat ER patients
Kaiser Health News
Feb. 21: Next time you go to an emergency room, be prepared for this: If your problem isn't urgent, you may have to pay upfront. In 2011, about 80,000 emergency-room patients at hospitals owned by HCA, the nation's largest for-profit hospital chain, left without treatment after being told they would have to first pay $150 because they did not have a true emergency.More

What court decision means for insurers, hospitals and drugmakers
The Washington Post
July 3: The Supreme Court ruled that the healthcare law stands. For months now the pending ruling has put the Affordable Care Act's future in limbo. Now everyone knows it has survived and — while other challenges are still ahead — it gives a bit more guidance on where things head next. Here's a look at what that means for three major healthcare sectors.More

Same doctor visit, double the cost
The Wall Street Journal
Aug. 28: A structural shift is sweeping through healthcare in the United States — Hospitals are increasingly acquiring private physician practices. Hospitals say the acquisitions will make healthcare more efficient. But the phenomenon, in some cases, also is having another effect: higher prices. As physicians are subsumed into hospital systems, they can get paid for services at the systems' rates, which are typically more generous than what insurers pay independent doctors.More

WellPoint to buy Amerigroup for $4.5 billion
July 10: Health-benefits provider WellPoint is set to pay $4.5 billion for managed-care company Amerigroup, a move into the burgeoning Medicaid market. Amerigroup shareholders will receive $92 a share in cash. The transaction should close in the first quarter of 2013, WellPoint says. The deal is expected to give WellPoint access to Medicaid customers in 19 states, servicing some 4.5 million people.More

Remember managed care? It's quietly coming back
The Wall Street Journal
Aug. 7: Under pressure to squeeze out costs, some of the United States' biggest health insurers are quietly erecting more hurdles for patients seeking medical care. The companies are in many cases reaching back to the 1990s and boosting the use of techniques that antagonized patients and doctors alike. Today's approaches are tweaked, but may feel familiar to many: Insurers are rolling out plans with more restricted choices of doctors and hospitals, and weighing new requirements for referrals before patients can see specialists.More

Venture capitalists change their healthcare investments
March 13: Hospitals once souped up surgical suites with robots or high-tech radiation machines for cancer treatment. Cost wasn't an issue: They just got passed along to insurance companies, who passed them on to employers and patients. But after the Great Recession hit and the 2010 health law passed, the financiers behind the medical arms race started to rethink their investment calculus.More

Healthcare reform: The unintended impact on children
Feb. 28: When healthcare reform was passed in 2010, many applauded the provision that children could no longer be denied health insurance coverage due to pre-existing conditions, but there's decidedly less clapping now. "As an unintended consequence of health reform, a lot of insurers stopped offering individual coverage for children. That put parents in a bind, and children in danger."More

US set to sponsor health insurance plans nationwide
The New York Times
Oct. 10: The Obama administration will soon take on a new role as the sponsor of at least two nationwide health insurance plans to be operated under contract with the federal government and offered to consumers in every state.More

US watchdog blasts Medicare quality insurance project
April 24: Medicare, the U.S. healthcare program for the elderly, is spending more than $8 billion on a quality-improvement project for private health coverage that mainly rewards plans with mediocre performances, a U.S. government watchdog said. A report by the Government Accountability Office recommends canceling the Medicare Advantage quality bonus payment project in preference for quality improvements prescribed by President Barack Obama's healthcare law.More

Supreme Court orders another look at key healthcare provision
Nov. 27: The Supreme Court has ordered a federal appeals court to take another look at whether a key requirement in the healthcare reform law violates religious freedoms. A pending lawsuit from the private Liberty University had claimed, among other things, that the law would lead to taxpayer dollars funding abortions and contraception, a claim the Obama administration rejects.More