MCOL Weekend

MCOL WEEKEND

March 24, 2007 For Paid Members Volume 10 Issue 12




	In this Issue:

	Quote of the Week
	David Stefan, J.D. Power and Associates

	Sponsor Message
	National Medicaid Congress

	Weekly News
	1. Blue Cross Fined $1M; Dropped Policies 2. States seek to extend health care 3. Health-insurance merger in the works? 4. Leavitt Reassures Insurers in Fund Talks 5. UnitedHealthcare launches program to rate cardiac care facilities 6. House calls are back for some elderly Pa. patients 7. Blue Cross extends 'no-pay co-pay' plan 8. Report: Even the insured have trouble paying bills 9. Democrats take aim at health accounts 10. Doctors' Ties to Drug Makers Are Put on Close View

	MCOL Tidits
	J.D. Powers Health Plan Rankings

	Upcoming Healthcare Web Summit Events
	Scheduled audioconferences and web summits

	Paid Member Web Site
	Links to the paid member site


	"Privately held and BlueCross BlueShield plans tend to outperform public and non-Blue plans because members rate them higher for provider choice, coverage and benefits, and because they are engaging members more effectively with health-related information and communications," David Stefan, Executive Director, Healthcare, J.D. Power and Associates


	NATIONAL MEDICAID CONGRESS NATIONAL MEDICAID CONGRESS, June 13 - 15, 2007, www.MedicaidCongress.com, at the Renaissance Hotel in Washington, DC, powered by the Avalere Health And sponsored by Health Affairs and Harvard Health Policy Review. Featuring Newt Gingrich, Congressman Henry Waxman, Drew E. Altman, PhD, Karen Davis, President, The Commonwealth Fund, Robert S. Galvin, MD, MBA, Director, GE Global Healthcare, Kevin W. Concannon, Director, Iowa DHHS, Carmen Hooker Odom, Secretary, North Carolina DHHS, Sandra Shewry, Director, California DHS and a faculty of over 75 national experts. For information: go to www.MedicaidCongress.com, call 800-684-4549 or email registration@hcconferences.com.

Weekly News

1. Blue Cross Fined $1M; Dropped Policies
State regulators fined California's largest health insurance provider $1 million for violating state law, saying an investigation found that the company systematically dropped policyholders after they became sick or pregnant. Officials with the Department of Managed Health Care said they hoped the fine would prompt changes at Blue Cross of California, and they plan similar investigations into other health insurance providers in the state, the Los Angeles Times reported Friday.
Washington Post, March 23, 2007
http://www.washingtonpost.com/wp-dyn/content/article/2007/03/23/AR2007032300563.html

2. States seek to extend health care
U.S. states want to provide health care coverage for the uninsured, but daunting costs could derail or shrink some of their plans. Everybody is for more health insurance, particularly when you're not paying for it. That's the trick. How are you going to pay for it?" said Robert Kaestner, a professor at the University of Illinois' Institute of Government and Public Affairs. Proposals for broad expansion of health coverage have surfaced in 21 states and bills are pending in 16 legislatures, according to the National Conference of State Legislatures. Universal health care access was approved by Maine in 2003 and by Massachusetts and Vermont last year.
Washington Post, March 23, 2007
http://www.washingtonpost.com/wp-dyn/content/article/2007/03/23/AR2007032300848.html

3. Health-insurance merger in the works?
The boards of Independence Blue Cross, of Philadelphia, and Highmark Inc., of Pittsburgh, plan to meet separately Wednesday for a vote on merging the state's two largest health insurers. "There's consensus to go forward," said Patrick J. Eiding, one of the board members of Independence Blue Cross. The two companies have talked about mergers before without reaching agreement, and the status of on-again, off-again negotiations has been a constant source of talk within the health insurance community.
The Philadelphia Inquirer, March 23, 2007
http://www.philly.com/inquirer/home_top_stories/20070323_Insurer_merger_in_the_works_.html

4. Leavitt Reassures Insurers in Fund Talks
The Bush administration reassured worried health insurance executives Thursday that it strongly opposes efforts to cut their payments and use the savings to expand a separate insurance program for children. Health and Human Services Secretary Mike Leavitt said that cutting managed care payments to insurers serving the elderly is part of a broader effort by some lawmakers to get the federal government to run health care.
The Washington Post/Associated Press, March 22, 2007
http://www.washingtonpost.com/wp-dyn/content/article/2007/03/22/AR2007032200913.html

5. UnitedHealthcare launches program to rate cardiac care facilities
UnitedHealthcare said Thursday it will launch a program to provide consumers with better access to information on cardiac-care facilities. The unit of Minnetonka-based UnitedHealth Group (NYSE: UNH) said that they are making the move in response to a recent study published in the New England Journal of Medicine, which found a need for more, "round-the-clock" access to quality urgent cardiac care. The study showed that higher mortality rates occurred in patients admitted for heart attacks on weekends versus weekdays.
American City Business Journals/Minneapolis /St. Paul, March 22, 2007
http://twincities.bizjournals.com/twincities/stories/2007/03/19/daily32.html

6. House calls are back for some elderly Pa. patients
For some of the most frail and chronically ill of the region's elderly population, an old-fashioned practice is back: doctor house calls. Independence Blue Cross, one of the region's largest insurers, is implementing a program in which doctors come calling to 500 Medicare patients in southeastern Pennsylvania. The program is free to the patients, who generally have at least two chronic illnesses and have been hospitalized at least twice in the previous year.
Pittsburgh Tribune-Review/Associated Press, March 22, 2007
http://www.pittsburghlive.com/x/pittsburghtrib/news/breaking/s_499011.html

7. Blue Cross extends 'no-pay co-pay' plan
To steer more of its members to cheaper generic drugs, Independence Blue Cross is extending its "no-pay co-pay" program for the rest of 2007. The program, initially scheduled for just the first quarter of this year, allows 1.2 million of the health insurer's 3.4 million subscribers to get generic drugs for free. Other insurance companies have used lower co-payments or waived co-pays temporarily to induce members to try generics, but Blue Cross' effort is unusually extensive.
The Philadelphia Inquirer, March 22, 2007
http://www.philly.com/philly/health_and_science/20070322_Blue_Cross_extends_no-pay_co-pay_plan.html

8. Report: Even the insured have trouble paying bills
When Janet Fredrick got breast cancer in 1998, she never thought she would face bankruptcy because of medical bills: She had insurance. But her illness dragged out, then her income plunged when she went on disability. By 2005, her co-payments for treatment, including surgery, medications, doctor visits and hospital care, totaled about $8,000. Such co-payments and deductibles, along with difficult-to-understand policies and complex hospital billing issues, are among the main reasons even people such as Fredrick who have health insurance can face devastating financial costs, says a report out today from The Access Project, an advocacy group that researches medical debt.
USA TODAY, March 22, 2007
http://www.usatoday.com/printedition/money/20070322/insure22.art.htm

9. Democrats take aim at health accounts
A battle is brewing in Congress over a key piece of the Bush administration's strategy to lower health care costs, as Democrats plan to roll back a Republican-backed expansion of health savings accounts. The accounts, which were introduced in January 2004, cover nearly 5 million people and are thought to hold as much as $5 billion in investments.
The Washington Times, March 21, 2007
http://www.washtimes.com/business/20070321-121702-4910r.htm

10. Doctors' Ties to Drug Makers Are Put on Close View
Dr. Allan Collins may be the most influential kidney specialist in the country. He is president of the National Kidney Foundation and director of a government-financed research center on kidney disease. In 2004, the year he was chosen as president-elect of the kidney foundation, the pharmaceutical company Amgen, which makes the most expensive drugs used in the treatment of kidney disease, underwrote more than $1.9 million worth of research and education programs led by Dr. Collins, according to records examined by The New York Times. In 2005, Amgen paid Dr. Collins at least $25,800, mostly in consulting and speaking fees, the records show.
The New York Times, March 21, 2007
http://www.nytimes.com/2007/03/21/us/21drug.html

MCOL Tidbits

J.D. Powers Health Plan Rankings

While J.D. Powers is better know for publishing consumer satisfaction rankings with automobiles, they also conduct research in a number of other areas, including healthcare, having previously produced reports on vision retailer rankings, vision plan rankings, distinguished hospitals and distinguished health plans. Now J.D. Powers has weighed in with their own Health Plan Rankings, based upon their 2007 National Health Insurance Plan satisfaction Study released this month.

The J.D. Powers 2007 National Health Insurance Plan Satisfaction Study included responses from 10,552 members, representing large commercial health plans. The study examined the member satisfaction performance of 49 large health plan companies in the four U.S. Census regions. Criteria for inclusion were plans with approximately 750,000 members across all commercial products, excluding Medicare and Medicaid.

Seven satisfaction factors were taken into account for the rankings. According to the study, consumer ranked the these factors as contributing to overall health plan satisfaction as follows:

Coverage and Benefits- 28%
Choice of Providers - 18%
Information and Communication - 17%
Approval Processes - 15%
Insurance Statements - 9%
Customer Service - 8%
Claims Processing - 5%

According to David Stefan, executive director of the healthcare practice at J.D. Power, "privately held and BlueCross BlueShield plans tend to outperform public and non-Blue plans because members rate them higher for provider choice, coverage and benefits, and because they are engaging members more effectively with health-related information and communications." J.D. Powers also concluded that "respondents in the West rate their plans lower overall and on all seven factors when compared with the three other U.S. Census regions examined. In particular, health plans in the West receive lowest scores for claims processing and information and communication."

The study assigned a numerical index ranking for each plan according to a 1,000 point scale, with plan scores ranging between 698 and 785. We calculated the percent of each region's average for major plans, with the percents ranging from 96.1% to 106.7%. Tables are provided below.

Northeast	Score	% of Avg	South	Score	% of Avg
Harvard Pilgrim	785	105.2%	BCBS of FL	779	104.4%
Tufts	771	103.4%	BCBS of AL	773	103.6%
Highmark	762	102.1%	BCBS of NC	761	102.0%
Anthem	759	101.7%	Anthem	757	101.5%
Excellus BCBS	757	101.5%	BCBS of GA	749	100.4%
BCBS of MA	755	101.2%	BCBS of TN	742	99.5%
Empire BCBS	743	99.6%	UnitedHealthcare	741	99.3%
Horizon	739	99.1%	CareFirst BCBS	740	99.2%
Group Health Inc	737	98.8%	Aetna	736	98.7%
UnitedHealthcare	735	98.5%	Kaiser	735	98.5%
Aetna	733	98.3%	CIGNA	732	98.1%
Cigna	728	97.6%	Humana	729	97.7%
Oxford	722	96.8%	BCBS of TX	725	97.2%
NE Avg.	746	100.0%	South Avg.	746	100.0%

Midwest	Score	% of Avg	West	Score	% of Avg
BCBS of MN	771	104.3%	Premera	775	106.7%
BCBS of MI	762	103.1%	Regence	754	103.9%
Wellmark	754	102.0%	BCBS of AZ	746	102.8%
BCBS of IL	748	101.2%	Kaiser	746	102.8%
BCBS of MO	740	100.1%	UnitedHealthcare	729	100.4%
Medical Mutual	738	99.9%	Anthem	725	99.9%
Aetna	733	99.2%	PacifiCare	723	99.6%
UnitedHealthcare	732	99.1%	CIGNA	723	99.6%
CIGNA	728	98.5%	Blue Shield of CA	709	97.7%
Humana	713	96.5%	HealthNet	705	97.1%
Anthem	712	96.3%	Blue Cross of CA	699	96.3%
Midwest Avg.	739	100.0%	Aetna	698	96.1%
			West Avg.	726	100.0%

Source: Source: J.D. Power and Associates 2007 National Health Insurance Plan Satisfaction Study

For More Information:

J.D. Power and Associates Reports:
BlueCross BlueShield and Privately Held Health Plan Enrollees Voice Greater Customer Satisfaction Compared with Members of Publicly Traded Companies
Press Release, March 15, 2007
http://www.jdpower.com/press-releases/pressrelease.aspx?id=2007041

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