Last Updated Aug 6, 2008 7:38 AM EDT Two items I recently stumbled across together highlight a looming clash between the sort of data-enabled "personal medicine" often touted as "Health 2.0" and dystopian fears that insurers' growing access to patients' digital medical information will increasingly restrict coverage -- or at least make it considerably more expensive. First, the dystopia. Earlier this week, the Washington Post revealed that health insurers can now obtain a sort of health "credit report" on individuals thanks to the vast store of digitized drug-prescription data now held by "pharmacy benefit managers" like ExpressScripts. Drug-use information, of course, is highly useful to insurers as a reliable proxy for an individual's health; as the story notes, if your data records show you've been on the highest dose of a cholesterol-lowering statin for 18 months, that signals you have an almost intractable cholesterol problem and face an elevated risk of heart attack or stroke. … [Read more...] about “Health 2.0” vs. Health Insurers: The Looming Clash
Healthcare vs health insurance
Last Updated Sep 24, 2008 11:35 AM EDT Health-insurance companies have gotten kicked around pretty good for the seemingly common practice of "rescission" -- essentially the post-hoc cancellation of individual insurance policies, often enough after a health-plan member falls ill and begins to rack up some serious medical bills. In a recent California scandal, for instance, health plans Kaiser Permanente, Health Net, WellPoint and UnitedHealth Group paid fines in the tens of millions and reinstated coverage for thousands of beneficiaries whose coverage was improperly dropped. Now Aetna, as part of its ongoing effort to cast itself as the good guy in the health-insurance biz, has announced new measures aimed at curbing unfair rescissions. According to the Hartford Courant, Aetna will now let members appeal rescission decisions to an independent panel of doctors either before or after contesting them via its own internal-review process. Aetna's name hasn't come up in any of the rescission … [Read more...] about Aetna Vs. Health-Insurance Rescission?
Last Updated Jan 15, 2009 10:34 PM EST As I noted in a roundup last week, Tufts Medical Center has thrown down the gauntlet to Blue Cross Blue Shield of Massachusetts by refusing to accept coverage by the state's largest health-insurance outfit unless the Blue agrees to hike reimbursement rates for Tufts doctors and the hospital itself. Tufts patients are already fretting that they'll have to find new doctors and might be shut out of the hospital if the two sides can't reach an agreement by Feb. 1. The Mexican standoff is the latest in a series of increasingly acrimonious battles between insurance companies and hospitals as the latter flex their newfound clout to demand higher payments. The timing for insurers, of course, couldn't be worse, since they've already hiked premiums to unaffordable levels for many employers and individuals -- all due to rising medical costs, they say. Hospitals aren't much better off, thanks to losses on their investment portfolios and declining patient … [Read more...] about Tufts Medical Vs. Blue Cross: The Hospital/Health Insurance Wars Get Nasty
Last Updated Jul 14, 2009 6:03 PM EDT The House Democrats unveiled their full reform proposal today, and not a moment too soon. I say that not because of President Obama's deadline of having both houses of Congress pass bills before the August break. I say it because all the signs point to a continuing breakdown of the healthcare system. Just in the past week, for instance, it was reported that emergency rooms and community clinics in the greater Washington, DC, area are overflowing because the recession has cost so many people their health insurance. And in Michigan, the downturn is said to be dragging down the healthcare system, which had been one of the few bright spots in the state's sputtering economy. On the other hand, the President's Council of Economic Advisors has just released a report predicting that healthcare jobs will be among those showing the biggest gains between now and 2016. A category called "other medical services and dentists," which includes employment in home … [Read more...] about Employment vs. Health Reform: A Real Conundrum
SACRAMENTO, Calif. - Predicting diminished competition and likely higher costs, a federal judge rejected Anthem’s (ANTM) bid to buy rival health insurer Cigna (CI). U.S. District Judge Amy Berman Jackson on Wednesday said the merger would significantly reduce competition in the already concentrated insurance market, particularly for large national employers. Cigna and Anthem are two of just four insurers selling to companies with 5,000 employees spread across multiple states, and they compete aggressively for business, the judge wrote. Berman Jackson was unconvinced by Anthem’s argument that the merged company could save money for customers by combining the two insurers’ different approaches to cost saving. Anthem has negotiated lower payments to doctors and hospitals, while Cigna has higher upfront expenses for wellness in the hopes of reducing future health expenses. “Eliminating this competition from the marketplace would diminish the opportunity for the … [Read more...] about Anthem-Cigna health insurance merger rejected by judge