Connecticut Health Care Redesign Plan Focuses on Primary Care, Doctor Payments and Reducing Waste

The ct Mirror is reporting that a team of state officials and health care industry representatives are trying to redesign the way health care is paid for and delivered to the vast majority of Connecticut residents.

According to a draft of their plan, their vision includes bolstering primary care practices to take on a larger role in patient care and offer treatment during expanded hours. It calls for better linking of medical practices with social services and other supports that could help people in high-risk communities. And it includes changing the way health care providers are paid by giving them an incentive to rein in what their patients’ care costs — a model that’s been embraced by Medicare and insurance companies but has drawn fire from patient advocates. Continue reading

Are CO-OPs Doomed to Fail?

Over on FierceHealthPayer is asking the question: Are Co-Ops doomed to fail? She notes that of the 24 Co-Ops now open for business, one has closed, another is struggling and at least nine other startup insurance companies are projected to have financial problems.

Where they not designed with enough financial support, or are there other problems at work? – See more at


New Look for Health Plan Innovation News

The Health Plan Innovation News has a new, fresher look. It will also give our readers the same great experience when using mobile devices and tablets as it does when using a computer.

Let us know what you think.


Hub and Spoke ACOs May be Hard Sell In U.S.

A post today on describes a new alliance in western Pennsylvania between Highmark Health Services and six Allegheny Health Network (AHN) hospitals as being “like an ACO without walls.”

The article, which was reprinted from THE AIS REPORT ON BLUE CROSS AND BLUE SHIELD PLANS, reported that this alliance is part of Highmark’s effort to accelerate the shift from volume-based, fee-for-service (FFS) payment to a system that pays for value.

Highmark describes the alliance, in this article, as a way to foster more integrated care, moving beyond primary care physicians (PCPs) in its Patient-Centered Medical Home (PCMH) program to add specialists and hospitals to the mix. Continue reading

CAQH CORE, the Quiet Side of the Affordable Care Act

With health care exchanges dominating the news with regard to the Affordable Care Act (ACA), another piece of the health care reform legislation that will affect more people than the individual mandate or the public exchanges is being implemented with much less fanfare and media attention.

Those are the sections of the law that require administrative simplification and the development of standards for financial and administrative transactions. Sections 1104 and 10109 of ACA will impact nearly everyone who uses, pays for or delivers health care.

Essentially these sections of the law are aimed at bringing the health care industry (hospitals, health plans and other stakeholders) to a place that the financial services industry has been for years. That is having universal standards in place that allow financial institutions to communicate with one another in the same electronic language. It is what allows someone to use an ATM at a bank branch or at a gas station.  Continue reading

BCBSM to Compare Michigan Hospitals Costs and Care

DETROIT—Blue Cross Blue Shield of Michigan, Blue Care Network, and the University of Michigan Health System have launched the Michigan Value Collaborative, an initiative aimed at helping hospitals across the state understand their practice patterns compared with their peers, better manage costs and improve outcomes for patients.

“This new initiative uses health care claims data to enable hospitals to see how they compare on the resources they use to deliver care to patients,” said David Share, M.D., M.P.H., senior vice president, Value Partnerships, Blue Cross Blue Shield of Michigan. “This initiative is unique in that it allows participating hospitals to see how they compare with other hospitals, and use that data to better connect their care practices and costs with outcomes. Hospitals will be able to adjust their practice patterns to benefit patients and the overall efficiency of our health care system.”

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NeHC: Engaging Consumers is Critical to Healthcare’s Future

The future of healthcare must include consumer engagement in eHealth according to Healthcare Informatics which cites  a new survey of stakeholders by the National eHealth Collaborative (NeHC) and its partner HealthCAWS, a healthcare services company.

National eHealth Collaborative (NeHC) is a public-private partnership that accelerates effective use of health IT to create a more patient and family centered healthcare system with better outcomes and greater value. NeHC works closely with the Office of the National Coordinator for Health IT in the U.S.  Continue reading

The Amish Health Care Plan

An article on reminds us that not all health plans are insurance plans. The article titled, “The Amish way of healthcare finance,” explains that the Amish have legally opted out of participating in the Affordable Care Act, but that does not mean they are doing without a plan for taking care of their member’s health care needs..

The article says that various Amish communities have negotiated prices with local hospitals for its members in exchange for quick cash payments. The communities then use a combination of church aid and benefit auctions to raise money for any member who is unable to pay their bill, according to Reuters.

“We have our own healthcare,” an anonymous Amish community member told Reuters. “They [hospitals] give you a bill,” he said. “If you can’t pay it, your church will.”

See the full story at:

Are Private Exchanges Good or Bad for Health Insurer Profits?

An article that appeared in today’s AISHealth is saying that health insurers could see their profit margins more than double if their large employer clients transition from a self-insured model to full risk via private insurance exchanges.

The article, which was reprinted from INSIDE HEALTH INSURANCE EXCHANGES, says that the Sept. 17, announcement that Walgreen Co. would move its 160,000 self-insured employees to Aon Hewitt’s multicarrier insurance exchange has gotten the buzz started. Continue reading

Trading Access for Price in Healthcare Exchanges

To add a follow up the the previous post about Independence Blue Cross (IBC) offering state exchange consumers “tiered networks,” Fierce Health News is reporting that hospitals are pushing back on limited health exchange networks.

A story on the FierceHealthcare website notes that Seattle Children’s Hospital has sued Washington state’s Office of the Insurance Commissioner, claiming the health insurance exchange will prevent some patients from receiving care at the hospital,

The article also points out that most plans sold through health insurance exchanges limit patient choice of doctors and hospitals, believing consumers will trade provider choice and access for lower premiums.

The questions is, do the people buying these plans know they are giving up access for a lower price, and do they care?

What do you think? Comment below.

See the full story at