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 contain costs and improve the quality of health care. 2009-11-21T15:15:53Z http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/CMS-making-changes-for-Medicare-plans/ArticleStandard/Article/detail/630634?contextCategoryId=977&ref=25 CMS wants to reduce low-value plans and improve information systems to help seniors shop for the best coverage options 2009-10-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/402009/630634null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Policy+%26+Regulation/Insurance-exchanges-key-to-expanding-coverage/ArticleStandard/Article/detail/622633?contextCategoryId=977&ref=25 Exchanges could channel subsidies, specify plan design and provide an efficient way to enroll members 2009-09-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/362009/622633null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Policy+%26+Regulation/New-taxes-pay-for-reform/ArticleStandard/Article/detail/607972?contextCategoryId=977&ref=25 Sin taxes and taxes on benefits could raise a portion of the $1 trillion we need 2009-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272009/607972null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Policy+%26+Regulation/Insurers-pledge-to-back-health-system-reforms/ArticleStandard/Article/detail/601155?contextCategoryId=977&ref=25 Major concessions aim to dilute support for other, more onerous regulations 2009-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/232009/601155null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Policy+%26+Regulation/Medicare-Advantage-overpayments-face-ax/ArticleStandard/Article/detail/590436?contextCategoryId=977&ref=25 MedPAC reports 2009 MA payments will be 14% above fee-for-service rates. 2009-04-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/142009/590436null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Public-plan-pitched-as-alternative/ArticleStandard/Article/detail/584948?contextCategoryId=977&ref=25 One way to level the playing field is to offer the public plan through an administered market system. 2009-03-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102009/584948null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Congress-hopes-to-cut-MA-excess/ArticleStandard/Article/detail/573821?contextCategoryId=977&ref=25 Congress is looking to reign in excessive payment to MA plans, especially PFSS, in order to bring them closer to FFS rates 2009-01-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/022009/573821null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Healthcare-reform-campaign-faces-big-hurdles/ArticleStandard/Article/detail/569635?contextCategoryId=977&ref=25 The economy trumps all for President-elect Obama, so healthcare spending must be re-examined if programs stand any chance of succeeding 2008-12-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/492008/569635null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Congress-boosts-mental-health-treatment/ArticleStandard/Article/detail/562101?contextCategoryId=977&ref=25 Plans can no longer charge higher copays or limit the number of visits for behavioral or mental health benefits, thanks to a new law 2008-11-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/442008/562101null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Healthcare+Reform/Medicare-Part-D-facing-new-overhaul/ArticleStandard/Article/detail/557623?contextCategoryId=977&ref=25 Even though the Medicare prescription drug benefit has provided access to medicines at less-than-anticipated cost to the government - and lower out-of-pocket spending for seniors - Democrats and consumer advocates are gearing up for a battle to overhaul the program. 2008-10-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/412008/557623null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Healthcare+Reform/Coverage-rescissions-draw-Congressional-scrutiny/ArticleStandard/Article/detail/547905?contextCategoryId=977&ref=25 Congress has joined states and consumer groups taking action against health insurers for revoking coverage for thousands of individual policy holders. 2008-09-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/362008/547905null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Medicare%2FMedicaid+products/Medicare-Advantage-plans-on-the-ropes/ArticleStandard/Article/detail/533520?contextCategoryId=977&ref=25 In enacting legislation to delay a reduction to Medicare physician fees, Capitol Hill Democrats demonstrated their intent to undermine the role of private insurers in providing care to seniors. Although all sides agreed to avoid a big cut in Medicare payments to doctors, Republicans fought efforts to fund the fees by reducing payments to Medicare Advantage plans. 2008-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322008/533520null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Cost-cutting-must-occur-ahead-of-reforms/ArticleStandard/Article/detail/528020?contextCategoryId=977&ref=25 Although there is strong interest in providing universal coverage for Americans, there is a growing sense that any coverage mandate must follow other changes so insurance is made more affordable first. 2008-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272008/528020null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Health-reforms-set-comparative-research-goals/ArticleStandard/Article/detail/522493?contextCategoryId=977&ref=25 As the 2008 presidential campaign moves into its final stages, there is much enthusiasm within both parties for developing objective information on the effectiveness of medical treatments and therapies in real-world settings. 2008-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242008/522493null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Demand-grows-for-transparent-quality-measures/ArticleStandard/Article/detail/515150?contextCategoryId=977&ref=25 The health-quality measurement bandwagon is picking up steam these days as both public and private payers struggle to deal with rising costs and the need to ensure quality care. Medicare has greatly enhanced its "Hospital Compare" Web site by posting the results of a patient survey on satisfaction with care during hospital stays. 2008-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192008/515150null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Grants-help-doctors-transition-to-e-prescribing-pl/ArticleStandard/Article/detail/508002?contextCategoryId=977&ref=25 Despite widespread enthusiasm for establishing interoperative electronic health records, progress has been slow in developing the standards, protocols and rules needed to move from small initiatives to a national e-health system. To stimulate action, the Bush administration and major players in the e-health community are promoting electronic prescribing systems as an achievable step toward broader interconnectivity. Health plans and insurers are backing these efforts as a way to prevent medication errors and improve quality of care. 2008-04-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/152008/508002null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/CMS-beefs-up-MA-Part-D-marketing-oversight/ArticleStandard/Article/detail/500098?contextCategoryId=977&ref=25 In response to continued complaints from Medicare beneficiaries about unscrupulous sales reps and misleading plan information, members of Congress and state insurance regulators are urging better oversight of Medicare Advantage and Part D plans. The Centers for Medicare and Medicaid Services (CMS) says it is beefing up policies and enforcing rules with more vigor. 2008-03-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102008/500098null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/MA-plan-payments-practices-face-increased-scrutiny/ArticleStandard/Article/detail/489462?contextCategoryId=977&ref=25 Medicare Advantage plans escaped threatened payment cuts last year, but the issue is at the top of the health policy legislative agenda for the coming months. Legislation enacted in late December postponed a scheduled reduction in Medicare payments to physicians—but only for six months. Congress paid for that short delay plus an extension of the State Children's Health Insurance Program (SCHIP) without cutting MA rates or raising taxes. 2008-02-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/062008/489462null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Employer-based-healthcare-system-under-scrutiny/ArticleStandard/Article/detail/476115?contextCategoryId=977&ref=25 As the debate over healthcare reform accelerates, policy makers are weighing in with proposals to unlink coverage from the work place. 2007-12-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/482007/476115null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Attack-mounts-on-high-payments-to-Medicare-plans/ArticleStandard/Article/detail/469643?contextCategoryId=977&ref=25 Pressure is mounting on Capitol Hill once again to ax payments to Medicare Advantage plans. The legislators need to save $10 billion in order to rescind a planned cut in Medicare rates for physicians by year-end. Conveniently, the Congressional Budget Office (CBO) estimates that equalizing payments between MA plans and fee-for-service Medicare will save $50 billion over five years. If Congress wants to expand the State Children's Health Insurance Program (SCHIP) and keep physicians happy, "excessive" MA rates are the prime target. 2007-11-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/442007/469643null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Part-D-brings-more-drug-coverage-to-seniors/ArticleStandard/Article/detail/462214?contextCategoryId=977&ref=25 There has been a lot of good news about the Medicare drug benefit lately. Surveys show a substantial increase in coverage, particularly among low-income seniors. Costs are less than expected; employers continue to offer retiree benefits; major insurers are sticking with the program; and product coverage remains fairly broad. Beneficiaries seem generally satisfied with the program, and the much-feared "donut hole" appears less lethal than anticipated. 2007-10-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/402007/462214null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Congress-battles-White-House-over-SCHIP-expansion/ArticleStandard/Article/detail/452859?contextCategoryId=977&ref=25 The need to reauthorize the State Children's Health Insurance Program (SCHIP) by September 30, has evolved into a broader debate about the role of government in providing healthcare to Americans. The Bush administration wants to maintain a limited program for low-income children, while Democrats envision more open-ended coverage for more children and families. 2007-09-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/352007/452859null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/All-eyes-on-Massachusetts-health-reform-Universal-/ArticleStandard/Article/detail/446458?contextCategoryId=977&ref=25 The landmark Massachusetts healthcare reform plan requires all adults in the state to have purchased health insurance by July 1, and policy makers are scrutinizing whether the combination of "carrots" and "sticks" has spurred compliance. The legislation, adopted in April 2006, aims to establish universal coverage by subsidizing insurance for lower-income individuals and penalizing those with higher incomes who fail to sign up. Employers with more than 10 workers have to play or pay: provide coverage to employees or pay an annual fee. 2007-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/312007/446458null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Health-IT-implementation-slows-down-Lack-of-legisl/ArticleStandard/Article/detail/439156?contextCategoryId=977&ref=25 The long-sought national interoperable health information system remains far from reality as standards prove difficult to establish, provider uptake goes slowly and privacy concerns continue. A year ago, there were high expectations that Congress would adopt legislation supporting the creation of standards for electronic health records (EHRs). That bill faltered over disagreements about anti-kickback language and new billing codes. 2007-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/272007/439156null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Plans-seek-more-comparative-health-information-Ins/ArticleStandard/Article/detail/433322?contextCategoryId=977&ref=25 Economists and health experts on all sides are clamoring for more evidence on how medical products and procedures compare in safety, efficacy and cost. Legislative proposals before Congress include a range of initiatives to spur more comparative effectiveness (CE) research. 2007-06-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/242007/433322null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Senators-challenge-proposals-to-cut-MA-rates/ArticleStandard/Article/detail/424945?contextCategoryId=977&ref=25 Despite a mounting clamor for reform from many health policy experts, Senate action to reduce payments to Medicare Advantage may be postponed this year. Influential senators oppose an across-the-board cut, which would reduce MA plan activity in rural and low-cost regions. 2007-05-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/192007/424945null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Healthcare-measures-top-Congressional-agenda/ArticleStandard/Article/detail/415864?contextCategoryId=977&ref=25 The State Children's Health Insurance Program (SCHIP) will expire September 30, 2007, unless Congress approves legislation reauthorizing this popular program offering healthcare services for children and some adults. The deadline puts this issue at the top of the Congressional agenda as an opportunity for Democratic leaders to increase public access to care. Efforts to expand coverage for children and secure the Medicare program are important to the managed care community because the legislators are eyeing "overpayments" to Medicare Advantage plans as a possible source for some $50 billion to fund SCHIP and other healthcare programs. 2007-04-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/142007/415864null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Medicare-Advantage-plans-under-attack/ArticleStandard/Article/detail/409178?contextCategoryId=977&ref=25 Rising pressure to reduce federal spending for Medicare has put the spotlight on payments and policies governing the Medicare Advantage program. MA plans are "vastly overpaid," according to Rep. Pete Stark (D-Calif.), chairman of the House Ways & Means Health subcommittee, largely because they sign up more healthy beneficiaries. Senate Finance Committee chairman Max Baucus (D-Mont.) is looking closely at whether "funneling dollars into private plans gets us the most bang for our healthcare buck." 2007-03-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/102007/409178null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Congress-moves-to-curb-Medicare-drug-spending/ArticleStandard/Article/detail/401866?contextCategoryId=977&ref=25 The new House leadership delivered on one of its prime campaign promises last month by pushing through legislation requiring the Health and Human Services (HHS) secretary to negotiate directly with pharmaceutical companies on prices for medications covered by the Medicare drug benefit. The bill (HR 4) repeals the so-called "non-interference" clause in the Medicare Modernization Act (MMA) and replaces it with a provision requiring the secretary to negotiate prices that manufacturers may charge prescription drug plans (PDPs) and Medicare Advantage drug plans (MA-PDs). 2007-02-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/052007/401866null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Congress-to-tackle-MA-rates-childrens-health-unins/ArticleStandard/Article/detail/396679?contextCategoryId=977&ref=25 The high-profile health policy issues for the new Congress are to reduce Medicare prescription drug prices and expand federal government funding for embryonic stem cell research. Congressional leaders want to enact legislation that will permit the federal government to negotiate drug prices (see Newswire), a move that eventually could alter the role of private plans in providing healthcare benefits to seniors. 2007-01-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/022007/396679null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Changing-of-the-guard-puts-spotlight-on-health-pol/ArticleStandard/Article/detail/389257?contextCategoryId=977&ref=25 The Democrats are back on top in the House and Senate after more than a decade playing second fiddle to the GOP. Although health reform was not a prime issue moving votes this November, health policy is on the Democrats' "100 hours" to-do list. 2006-12-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/482006/389257null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Part-D-puts-PBMs-in-the-political-spotlight/ArticleStandard/Article/detail/383206?contextCategoryId=977&ref=25 The emergence of pharmacy benefit management companies (PBMs) as major players in drug benefit design and pricing has generated criticism as well as praise. PBMs previously served as drug benefit administrators for employers and other payers. But as sponsors of Medicare Prescription Drug Plans (PDPs), they now assume risk and design coverage and payment options. 2006-11-01T05:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/442006/383206null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Medicare-faces-life-after-McClellan/ArticleStandard/Article/detail/376832?contextCategoryId=977&ref=25 To no one's surprise, Mark McClellan, MD, announced last month that he would leave his job as administrator of the Centers for Medicare and Medicaid Services (CMS) after six years with the Bush Administration. 2006-10-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/402006/376832null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/HHS-Congress-encourage-e-health-development/ArticleStandard/Article/detail/367913?contextCategoryId=977&ref=25 All health plans and providers that do business with Medicare, Medicaid and other federally sponsored health programs soon will have to adopt information technology standards and quality-measurement tools. The Medicare Modernization Act of 2003 (MMA) requires the Department of Health and Human Services (HHS) to establish standards for electronic prescription drug prescribing by 2008, and this policy is driving broader efforts to build health IT systems. 2006-09-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/352006/367913null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Medicare-insurers-seek-expansion-of-HSAs/ArticleStandard/Article/detail/363692?contextCategoryId=977&ref=25 Supporters of consumer-directed healthcare options want Congress to increase tax breaks and coverage limits to broaden the appeal of health savings accounts (HSAs) linked to high-deductible health plans. Health insurers and employers back legislation that would expand tax credits and higher HSA contribution limits plus increase flexibility in the use of HSA funds. 2006-08-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/322006/363692null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Prompt-pay-debate-pits-health-plans-against-pharma/ArticleStandard/Article/detail/357671?contextCategoryId=977&ref=25 The rhetoric is heating up as health insurers and pharmacy benefit managers (PBMs) try to fend off an escalating attack from retail pharmacists about late or lost payments. Delayed payments are "simply profits these giant corporations will pocket," says National Community Pharmacists Assn. CEO Bruce Roberts. "The PBM industry adds no value to the healthcare delivery system." 2006-07-01T04:00:00Z http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard/mhe/282006/357671null XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Gloomy-predictions-cloud-Medicares-future/ArticleStandard/Article/detail/329907?contextCategoryId=977&ref=25 The good news from Washington last month was that millions of seniors have signed up for the Medicare drug benefit, including some 6 million through Medicare Advantage prescription drug plans (MA-PDs). But troubling reports indicate that the Medicare program overall is in poor health and faces insolvency sooner than expected. In fact, President Bush may be compelled to propose significant cuts in Medicare spending next year if current trends continue. The remedies lie in higher taxes, reduced benefits, higher premiums for seniors and lower payments to plans and providers—none very attractive. 2006-06-01T04:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Medicare-plans-attract-seniors-more-scrutiny/ArticleStandard/Article/detail/322939?contextCategoryId=977&ref=25 The good news from the Centers for Medicare and Medicaid Services (CMS) is that more beneficiaries are joining Medicare Advantage plans, and that the trend is saving money for the federal government. CMS Administrator Mark McClellan, MD, announced last month that nearly 7 million seniors had enrolled in MA (Medicare Advantage) and MA-PD (Medicare prescription drug) plans, an increase of nearly 1 million since last fall. 2006-05-01T04:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/CMS-seeks-to-clarify-simplify-Medicare-drug-benefi/ArticleStandard/Article/detail/314984?contextCategoryId=977&ref=25 As the Centers for Medicare and Medicaid Services (CMS) tackles a host of start-up problems for the new Medicare prescription drug program, Administrator Mark McClellan, MD, is looking for ways to improve the system for next year. CMS has revised policies and updated information systems for Prescription Drug Plans (PDPs) and Medicare Advantage prescription drug plans (MA-PDs) in preparation for the 2007 contracting process, which begins in June. 2006-04-01T05:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/White-House-industry-promote-health-savings-accoun/ArticleStandard/Article/detail/311726?contextCategoryId=977&ref=25 The main strategy of the Bush administration for controlling healthcare costs and expanding access to care is to encourage more individuals and employers to adopt consumer-directed healthcare (CDHC) programs. Coverage programs that combine a high-deductible insurance policy with a tax-advantaged savings account for paying healthcare costs are becoming more widespread, according to recent surveys. They can save employers money, provide less-costly insurance to individuals, and they fit conservative Republican policies that shift more responsibility for healthcare decisions from insurers and providers to consumers. 2006-03-01T05:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Health-policy-moves-up-priority-list-for-Bush-admi/ArticleStandard/Article/detail/301712?contextCategoryId=977&ref=25 For consumers to make . . . decisions, they need more information on the performance and prices of medical services and products. 2006-02-01T05:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Medicare-consumerism-and-IT-to-shape-managed-care-/ArticleStandard/Article/detail/282708?contextCategoryId=977&ref=25 The managed healthcare market has been expanding, and the trend is likely to continue as employers and government agencies struggle to rein in spiraling healthcare costs. An aging population and more costly healthcare technology will aggravate current spending trends; these developments, in turn, will spur further consolidation among health plans and providers, stymie efforts to reduce the growing number of uninsured in the United States and drive innovative efforts to make consumers more aware of treatment costs and quality options. 2006-01-01T05:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/MCOs-use-drug-plans-to-attract-seniors/ArticleStandard/Article/detail/256154?contextCategoryId=977&ref=25 One reason so many insurers and health plans are sponsoring Medicare prescription drug plans (PDPs) is to attract traditional Medicare beneficiaries into the Medicare Advantage (MA) program. While there is considerable uncertainty about how stand-alone prescription drug plans (PDPs) will fare, insurers are willing to invest in the new drug coverage program to expand enrollment in local Medicare HMOs and PPOs, as well as new regional PPOs designed to attract seniors fearful of managed care. 2005-12-01T05:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Medicare-Advantage-poised-to-take-off/ArticleStandard/Article/detail/196470?contextCategoryId=977&ref=25 Hundreds of private insurers are marketing Medicare Advantage plans and state-wide PPOs with unexpectedly low prices for expanded drug coverage to gain a bigger slice of the radically changing Medicare pie. While the public has been focused on deciphering new prescription drug coverage options through stand-alone prescription drug plans (PDPs), Medicare officials also note an "enormous rise in MA plans with Part D benefits," reports Medicare Senior Advisor Abby Block. More than 5 million seniors now belong to MA plans, and the number is growing monthly. 2005-11-01T05:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Medicare-under-pressure-to-cut-costs/ArticleStandard/Article/detail/183305?contextCategoryId=977&ref=25 Elderly Americans will have to pay higher premiums for Medicare outpatient care next year than originally predicted to cover more doctors' office visits and increased use of hospital clinics. The rising expenditures also will boost payments to Medicare Advantage (MA) plans, further increasing overall program expenditures. While this trend may prompt more seniors to join MA plans, it also is fueling talk of cutting MA rates. 2005-10-01T04:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Campaign-begins-for-Medicare-drug-coverage/ArticleStandard/Article/detail/178276?contextCategoryId=977&ref=25 Competition Is heating up among insurers, pharmacy benefit managers (PBMs) and health plans as they ready major marketing campaigns to attract and enroll thousands of seniors in Part D Medicare prescription drug plans (PDPs). Insurers are offering hundreds of stand-alone and Medicare Advantage prescription drug plans (MA-PDs) in every region of the country, many promoting lower costs as a way to build market share. 2005-09-01T04:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Medicare-boosts-pressure-for-wise-choices/ArticleStandard/Article/detail/173308?contextCategoryId=977&ref=25 A few months ago, Medicare officials were worried that insurers and health plans might be reluctant to offer new PPO and prescription drug coverage options created by Medicare reform legislation. Now it looks like the agency's real problem is to help Medicare beneficiaries choose wisely among a multitude of coverage options. 2005-08-01T04:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Medicaid-budget-woes-mount-for-states-Congress/ArticleStandard/Article/detail/170531?contextCategoryId=977&ref=25 Rising Healthcare costs and growing uninsured populations are prompting state health officials to look for new ways to care for low-income and disabled populations. 2005-07-01T04:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Medicare-to-assemble-extensive-drug-utilization-da/ArticleStandard/Article/detail/164249?contextCategoryId=977&ref=25 Dr. Mark McClellan, administrator of the Centers for Medicare and Medicaid Services (CMS), plans to produce extensive information on how drugs and prescribing decisions affect health outcomes and costs by linking reimbursement data from Medicare prescription drug plans (PDPs) and Medicare Advantage (MA) plans with existing Medicare hospitalization and physician care databanks. 2005-06-01T04:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Promoting-and-paying-for-quality-care-raises-contr/ArticleStandard/Article/detail/159382?contextCategoryId=977&ref=25 PROVIDING BETTER quality care at lower cost has long been the Holy Grail of healthcare, but reaching this goal has been more difficult and controversial than anticipated. 2005-05-01T04:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/More-choices-arrive-for-Medicare-beneficiatires/ArticleStandard/Article/detail/155749?contextCategoryId=977&ref=25 Officials at the Centers for Medicare and Medicaid Services (CMS) began smiling last month. They were watching the letters and applications roll in from MCOs--;a sign that seniors will be able to obtain care from a large number of local PPOs (preferred provider organizations) beginning next January. 2005-04-01T05:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Medicare-implementation-is-the-main-event-for-HHS/ArticleStandard/Article/detail/150893?contextCategoryId=977&ref=25 IN HIS FIRST few days as Secretary of the Department of Health and Human Services (HHS), Mike Leavitt made waves by announcing plans to revise Medicaid and ensure drug safety. 2005-03-01T05:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Battle-resumes-over-medical-liability-reform/ArticleStandard/Article/detail/146109?contextCategoryId=977&ref=25 President George W. Bush began his second term by launching a high-profile campaign to limit skyrocketing medical malpractice insurance premiums for physicians and hospitals. 2005-02-01T05:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Bush-selects-former-Utah-Governor-Leavitt-to-head-/ArticleStandard/Article/detail/141940?contextCategoryId=977&ref=25 In a surprise move, President George Bush named former Utah Governor Michael Leavitt as the next secretary of the Department of Health and Human Services. 2005-01-01T05:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Healthcare-takes-a-back-seat-in-the-second-Bush-ad/ArticleStandard/Article/detail/136680?contextCategoryId=977&ref=25 Major initiatives to expand healthcare coverage to the uninsured or reform Medicaid are low on the priority list at the Bush White House. 2004-12-01T05:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/MA-enrollment-could-jump-to-66-million-in-coming-m/ArticleStandard/Article/detail/133401?contextCategoryId=977&ref=25 Health and Human Services Secretary Tommy Thompson happily announced last month that Medicare beneficiaries will have more coverage choices in 2005. 2004-11-01T05:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Rising-healthcare-premiums-challenge-MCOs-to-cut-c/ArticleStandard/Article/detail/127447?contextCategoryId=977&ref=25 The cost of family coverage under a PPO hit $10,000 this year, boosting concerns about the growing unaffordability of healthcare and future increases in the number of uninsured. 2004-10-01T04:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/MCOs-weigh-Medicare-rules-options/ArticleStandard/Article/detail/121932?contextCategoryId=977&ref=25 In late July, Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mark McClellan unveiled a massive proposed regulation for implementing the Medicare Modernization Act. The hundreds of pages of fine print (published in the Aug. 3, 2004, Federal Register) describes requirements for Medicare Advantage (MA) plans, subsidies for employers who continue retiree drug benefits, and rules to ensure that prescription drug plans (PDPs) provide adequate and appropriate medicines for seniors. There is considerable detail on PDP operations and benefit design, including copays and quality improvement programs, which apply to MA plans providing drug coverage to Medicare beneficiaries. 2004-09-01T04:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/MCOs-jump-on-health-savings-account-bandwagon/ArticleStandard/Article/detail/109641?contextCategoryId=977&ref=25 Recent legislation and regulations are encouraging payers and health plans to offer individuals more coverage options under the "consumer-directed health plan" label. Last year's Medicare Modernization Act (MMA) expanded tax breaks that make health savings accounts (HSAs) more attractive. 2004-08-01T04:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Campaign-accelerates--to-cover-the-uninsured/ArticleStandard/Article/detail/100527?contextCategoryId=977&ref=25 Healthcare access, Medicare rates will be hot issues in the election year debates 2004-06-01T04:00:00Z XML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Medicare-HMO-payment-increases-draw-fire/ArticleStandard/Article/detail/96833?contextCategoryId=977&ref=25 Democrats cry foul as analysts describe big jumps in rates for Medicare Advantage plans 2004-05-01T04:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/New-leader-to-tackle-Medicare-reforms-drug-benefit/ArticleStandard/Article/detail/93278?contextCategoryId=977&ref=25 McClellan takes over at CMS amidst escalating battle over drug imports 2004-04-01T05:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Examining-import-impact/ArticleStandard/Article/detail/93279?contextCategoryId=977&ref=25 This primary issue figures into upcoming elections 2004-04-01T05:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Health-plans-sweeten-their-Medicare-deals-for-seni/ArticleStandard/Article/detail/89087?contextCategoryId=977&ref=25 MCOs enhance benefits, cut fees to attract more Medicare beneficiaries 2004-03-01T05:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Health-coverage-costs-remain-hot-issues-for-2004/ArticleStandard/Article/detail/85870?contextCategoryId=977&ref=25 Election year campaigning focuses attention on rising healthcare costs and the need for universal coverage 2004-02-01T05:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Cost-control-pressures-spotlight-DM-and-cost-effec/ArticleStandard/Article/detail/78467?contextCategoryId=977&ref=25 MCOs seek to manage healthcare spending while expanding DM activities in Medicare 2003-12-01T05:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/MCOs-expand-strategies-to-keep-healthcare-affordab/ArticleStandard/Article/detail/75798?contextCategoryId=977&ref=25 As the pool of uninsured increases by 2.4 million, health plans look to offer more cost-management options 2003-11-01T05:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/MCOs-slow-M-C-drop-out-rate-but-face-HIPAA-hurdles/ArticleStandard/Article/detail/72525?contextCategoryId=977&ref=25 M+C plans eye expanded coverage for seniors if Congress boosts rates 2003-10-01T04:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Health-plans-top-priority--boost-M-C-rates-now/ArticleStandard/Article/detail/69437?contextCategoryId=977&ref=25 MCOs want flexibility while analysts challenge the ability of private plans to control costs 2003-09-01T04:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Medicare-reform-offers-pharmacy-benefits-some-comp/ArticleStandard/Article/detail/62584?contextCategoryId=977&ref=25 Policy makers question whether increased reliance on health plans will provide quality care while controlling costs 2003-07-01T04:00:00Z PDF http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Court-decisions-shape-health-plan-policies/ArticleStandard/Article/detail/56356?contextCategoryId=977&ref=25 High court rulings 
 shape health plan 
 policies. 2003-05-01T04:00:00Z PDF http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Medicare-reform-debate-moves-to-Capitol-Hill/ArticleStandard/Article/detail/54251?contextCategoryId=977&ref=25 Congress rejects White House Medicare pharmacy plan while moving forward
 with its own reform strategy 2003-04-01T05:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Medicare-reform-puts-managed-care-on-defensive/ArticleStandard/Article/detail/50391?contextCategoryId=977&ref=25 MCOs are on the front lines to deliver benefits, curb Medicare and Medicaid spending 2003-03-01T05:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/MCOs-face-legislativelegal-challenges/ArticleStandard/Article/detail/46061?contextCategoryId=977&ref=25 A sharp rise in healthcare spending puts the spotlight squarely on the
 erosion of managed care 2003-02-01T05:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Administration-backs-liability-reform-to-curb-spen/ArticleStandard/Article/detail/43791?contextCategoryId=977&ref=25 Initiatives that promote industry competition remain key to modernizing
 the nation's healthcare system 2003-01-01T05:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/GOP-political-agenda-highlights-healthcare-pharmac/ArticleStandard/Article/detail/40950?contextCategoryId=977&ref=25 Legislators seek Medicare "givebacks," malpractice reform,
 tax credits for health insurance 2002-12-01T05:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/States-struggle-to-finance-healthcare-programs/ArticleStandard/Article/detail/37927?contextCategoryId=977&ref=25 Officials don't expect the situation to improve as tax revenues decline
 and healthcare costs continue to rise 2002-11-01T05:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Liability-crisis-attracts-attention-on-Capitol-Hil/ArticleStandard/Article/detail/31989?contextCategoryId=977&ref=25 House panel examines soaring insurance rates, while analysts paint gloomy
 picture for M+C program 2002-09-01T04:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/House-compromises-on-Medicare-reform-measure/ArticleStandard/Article/detail/28952?contextCategoryId=977&ref=25 Vote helps M+C plans and pressures the Senate to act, while Homeland
 Security proposals raise concerns 2002-08-01T04:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/M-C-plans-get-temporary-relief/ArticleStandard/Article/detail/25504?contextCategoryId=977&ref=25 Bioterrorism bill gives MCOs more time to file rates for next year, as payment "give back" deliberations continue 2002-07-01T04:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Health-plans-providers-urge-legal-system-reform/ArticleStandard/Article/detail/22705?contextCategoryId=977&ref=25 Runaway litigation is boosting healthcare costs and reducing patient access to care 2002-06-01T04:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Budget-battle-pits-tax-relief-against-public-healt/ArticleStandard/Article/detail/20082?contextCategoryId=977&ref=25 Americans complain about access, while MCOs struggle with appeals, privacy
 and reimbursement 2002-05-01T04:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Shortfalls-threaten-Medicaid-and-Medicare-programs/ArticleStandard/Article/detail/17332?contextCategoryId=977&ref=25 Medicaid is on the rocks already, and the Medicare+Choice program isn't
 very far behind 2002-04-01T05:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Bush-budget-proposal-seeks-to-rescue-Medicare-Choi/ArticleStandard/Article/detail/12851?contextCategoryId=977&ref=25 Administration health agenda includes drug benefits for low-income seniors
 and support for patients' rights 2002-03-01T05:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/2002-elections-could-thwart-healthcare-issues-tabl/ArticleStandard/Article/detail/9913?contextCategoryId=977&ref=25 Legislators postponed key decisions on Medicare rates, mental health
 reform and assistance for the uninsured 2002-02-01T05:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Bioterrorism-forces-feds-MCOs-to-integrate-disease/ArticleStandard/Article/detail/6480?contextCategoryId=977&ref=25 The September terrorist attacks and the subsequent anthrax scare have
 prompted managed care organizations, healthcare providers and government
 agencies to expand emergency preparedness efforts and reevaluate policies
 and programs. Stung by criticism of its confusing response to the bioterrorism
 threat, the Department of Health and Human Services (HHS) has created a
 new Office of Preparedness and brought in new infectious disease and vaccine
 experts to rescue the situation. 2001-12-01T05:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/MCOs-continue-to-abandon-Medicare/ArticleStandard/Article/detail/6481?contextCategoryId=977&ref=25 Although fewer seniors will be forced to switch to new coverage options
 next year than did last January, MCOs still are dropping out of the Medicare+Choice
 program at a disturbing rate. Aggressive efforts by Tom Scully, administrator
 of the Centers for Medicare & Medicaid Services (CMS), encouraged some
 health plans to stick with the program for now, but dozens of MCOs abandoned
 or curtailed service areas when they filed cost proposals for contract year
 2002 in September. Consequently, 536,000 seniors will have to find new coverage
 by January, much less than the 934,000 affected by MCO departures last year.
 But many of those plans that remain are reducing optional benefits or raising
 premiums in order to continue coverage. 2001-11-01T05:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Managed-care-organizations-face-crisis-on-many-fro/ArticleStandard/Article/detail/6482?contextCategoryId=977&ref=25 When Congress returned from its August recess after Labor Day, it looked
 like partisan politics combined with a national economic slowdown might
 derail action on patients' rights legislation along with bills to reform
 the Medicare+Choice program or establish a Medicare drug benefit. Democrats
 and Republicans were having trouble agreeing on spending programs, and interest
 groups were squabbling over how to craft a fair pharmaceutical coverage
 program for seniors. 2001-10-01T04:00:00Z HTML http://managedhealthcareexecutive.modernmedicine.com/mhe/Politics+and+Policy/Showdown-or-slowdown-on-patients-rights-bill/ArticleStandard/Article/detail/6483?contextCategoryId=977&ref=25 After weeks of arm-twisting and back-room negotiating, House Republicans
 pushed through legislation last month to provide safeguards for patients
 in managed care plans. President George Bush and Rep. Charles Norwood (R-Ga.)
 set the stage for the vote by reaching a last-minute compromise on the all-important
 liability issue. The deal alienated Democrats, however, and might make it
 impossible for the two parties to reach a final agreement on legislation
 that President Bush will sign into law. 2001-09-01T04:00:00Z HTML