Hospital operators may fail to steer people with stroke symptoms to call 9-1-1 Jul 6, 2007
Jarrell and colleagues will conduct similar surveys with primary care physicians to determine the percentage of doctors that recognize symptoms and route patients to the ED. They will also research responses from 9-1-1 dispatchers and health maintenance organizations (HMOs). This study definitely suggests that, as a medical community, we are going to have to tighten the reins on who is giving information to patients with acute conditions and educate everyone on what stroke is, Jarrell said. (EurekAlert!)
Moore to Bush: Stop Pestering Me Jun 13, 2007
In a letter to the U.S. Treasury Department's Office of Foreign Assets Control, OFAC for short, Boies argued that Moore has become a government target due to the harsh criticism he lobs against the Bush administration and for-profit health maintenance organizations in the movie. "I am concerned that Mr. Moore has been selected for discriminatory treatment by your office," the attorney wrote Monday in response to a letter Dale Thompson, the chief of general investigations and field operations at... (E! Online)
Fox Systems aids Medicaid Jun 12, 2007
It also works with companies such as health maintenance organizations and with organizations that set technical standards in the health care industry. Founder Susan Fox started the company after coming to Arizona as a consultant on the Arizona Health Care Cost Containment System, the state's pioneering version of Medicaid. (AZCentral -- Business)
Medicare fraud on the rise in state May 20, 2007
The plan operates similar to health maintenance organizations. Individuals who sell Medicare Advantage plans must follow strict rules. (The Clarion-Ledger)
HMO profits drop in Florida May 14, 2007
A newly released report shows Florida health maintenance organizations posted a smaller total profit in 2005 than they did the year before. The profit numbers - $702. (South Florida Business Journal, FL)
State to schools: Begin trimming May 1, 2007
It also fired off letters to physicians, hospitals, health maintenance organizations and other health care providers telling them that state reimbursement for Medicaid funding to treat the poor, disabled and elderly will be cut by 6 percent. That would save the state's general fund $50 million, but the state also would forfeit $65 million in federal reimbursement dollars. (DetNews.com)
Statin drugs lower respiratory death risk Apr 11, 2007
Floyd Frost of the Lovelace Respiratory Research Institute in Albuquerque, New Mexico, and colleagues analyzed their institute's database of medical records from several health maintenance organizations. They looked at incidence of influenza and pneumonia and of COPD, and then cross-checked to see which patients were also taking statins. (CNN -- Health)
Insuring children may squeeze seniors Mar 26, 2007
The privately run alternatives to traditional programs serve about 8 million senior citizens, including those in health maintenance organizations, or HMOs. If funding is reduced, the plans may cut dental, vision and other benefits. (Los Angeles Times)
Trade group applauds Kaiser's interpreter program Mar 22, 2007
The innovation and community leadership award by , a national trade group for health maintenance organizations, was presented March 20 in Washington, D.C.. Kaiser's healthcare interpreter certificate program, operated in partnership with , addresses a serious shortage of formally trained healthcare interpreters, training programs and national standards. (Sacramento Business Journal, CA)
Effort to require medical translators goes into practice Mar 3, 2007
Health maintenance organizations must now ensure that their members receive services in a language that they understand, say consumer groups and officials at the California Department of Managed Health Care. Each managed care plan will be required to translate its written materials and make sure that interpreters are on hand when its members need medical care. (Scripps Howard News Wire)
Norwood's Patient's Bill of Rights back Feb 13, 2007
The bill would allow patients to sue health maintenance organizations for improper medical decisions. A statement from Norwood's office said he "acknowledged he will not be able to further impact debate on the legislation, but was confident Chairman Dingell and other supporters would see the bill passed into law this session.". (Atlanta Journal-Constitution -- World)
Hospital's new vision Jan 7, 2007
Hospitals in Southern California, where health maintenance organizations dominate the market, have had a particularly tough time bargaining for more favorable reimbursement rates. HMO contracts are especially critical to hospitals such as Alvarado that care for a disproportionately large number of patients covered by Medicare and Medi-Cal, the government health care programs that pay notoriously low amounts for hospital services. (San Diego Union-Tribune -- Business)
Paradise Valley Hospital severs Molina's contract Dec 1, 2006
Paradise Valley Hospital has ended its relationship with managed care insurer Molina Healthcare and has threatened to cut off at least three other health maintenance organizations unless they agree to more favorable contract terms with the National City hospital. Molina's 9,400 members who had been receiving care at Paradise now will be treated in nearby Chula Vista at Sharp Chula Vista Medical Center and in San Diego at Sharp Memorial Hospital, Sharp Mary Birch Hospital for Women and Rady... (San Diego Union-Tribune -- Business)
State Judge Rules Against HMOs Nov 30, 2006
Health maintenance organizations that are paid almost $700 million by Connecticut taxpayers to care for low-income residents must tell the public how they spend the state's money, a Superior Court judge said Wednesday. The ruling was a victory for advocates for the poor, who demanded the information because they believe the HMOs are paying doctors so little that many refuse to treat patients covered by the state-paid Medicaid health insurance program. (FOX61, CT)
Rising costs make HMOs less popular Nov 20, 2006
Health maintenance organizations, known for their low-cost medical care, were all the rage just 10 years ago. Today consumers are bailing out of HMOs in record numbers as their costs have risen as fast as other high-deductible health insurance plans that offer more doctor choices and services. (Sun-Sentinel.com)
Doc's remedyoften disputed Nov 20, 2006
No longer would the hospital honor transfer requests from health maintenance organizations seeking to save money by moving their members to hospitals operating within their health plans ... Cancels contracts with health maintenance organizations and renegotiates agreements to care for their patients at higher rates. (San Diego Union-Tribune)
Most children not getting two doses of flu vaccine Nov 13, 2006
The Vaccine Safety Datalink project is a population-based study of children enrolled in health maintenance organizations across the United States. Data for 125,928 children between 6 months and 8 years, receiving TIV for the first time, were analyzed by Dr. Lisa A. Jackson of the Group Health Center for Health Studies in Seattle, Washington, and colleagues with the project. (CNN -- Health)
Pay for Performance in Commercial HMOs Nov 2, 2006
Methods We surveyed a sample of 252 health maintenance organizations (HMOs) (response rate, 96%) drawn from 41 metropolitan areas across the nation about use of pay for performance. We determined the prevalence of pay-for-performance programs, detailed the features of such programs, and examined the adoption of pay for performance as a function of the characteristics of both the health plans and markets. (New England Journal of Medicine)
Aetna Health Oct 24, 2006
Separate Florida court rulings could give doctors more leverage in negotiating favorable payment rates with health maintenance organizations. If two class action lawsuits are successful, the five HMOs targeted could have to pay doctors millions of dollars. (South Florida Business Journal, FL)
News in brief from Northern California Sep 29, 2006
SACRAMENTO (AP) - Californians now have free access to an online report card evaluating nine major health maintenance organizations. The state Office of the Patient Advocate launched the service Wednesday in an effort to examine not only overall HMO quality of care but also how each one addresses major medical conditions such as cancer, diabetes and heart disease, according to a press release by the office. (Fresno Bee -- State)
Gabrieli, known for his wealthtries to stress currency of ideas Sep 13, 2006
As a candidate, he was excoriating health maintenance organizations for cost-cutting by restricting care, even as his old company, under new management, boasted about crackdowns on inefficient doctors and excessive treatments. The venture business taught him the art of negotiation and an appreciation of ``the co-ownership model," Gabrieli said. ``. . . We either make it all together, or we don't.". (Boston Globe)
EDITORIAL: Ehrlich for governor, Steele for Senate Sep 7, 2006
A partial list includes: a medical malpractice "reform" bill that included a tax on health maintenance organizations; a discriminatory, punitive tax against Wal-Mart pushed by organized labor and Wal-Mart competitors like Giant Food; a minimum-wage increase that will destroy jobs for the most unskilled workers; an ill-considered bill dealing with Baltimore Gas and Electric Corp. rates; and an early-voting scheme that lacked meaningful safeguards against election fraud, which the courts had the... (Washington Times)
Insurance superintendent orders HMOs to repay $71M Aug 19, 2006
Health maintenance organizations in New York must return a total of $71 million to policyholders in the individual direct-pay market. State Superintendent of Insurance Howard Mills ordered the distribution of the funds, which represent surplus money that has accumulated in two department-administered market stabilization pools. (Albany Business Review, NY)
More of this story Aug 15, 2006
In addition, Atmore Community Hospital will also be a participating provider for all United Healthcare products including, health maintenance organizations (HMOs), preferred provider organizations (PPOs) and Medicare Advantage. "We were glad that they were able to work out an arrangement that was fair to us and fair to them," hospital administrator Bob Gowin said. (Atmore Advance, AL)
Bush issues budget recommendations Jul 20, 2006
1 million increase over this year, but funding recommendations include proposals to hold the line on rate increases for hospitals, nursing homes and health maintenance organizations. The governor and his lieutenant also called for a new method to control spending on prescription drugs. (South Florida Business Journal, FL)
Consumers have tool to evaluate cost, quality of hospitals, HMOs Jul 9, 2006
The has released what may be the nation's first "report card" to look at the quality and costs of both hospitals and health maintenance organizations. The interactive report is searchable by county and allows the user to create customized, localized reports comparing data for various HMOs and hospitals. (Albany Business Review, NY)
CalPERS increases HMO rates Jun 23, 2006
6 percent increase in premiums for members of health maintenance organizations. While board members explored the idea of boosting co-payments in an attempt to combat rising premiums, they voted to keep most of its current health care benefits structure intact while looking for more ways to reduce costs. (San Francisco Chronicle)
Eye care giant slapped in court Jun 15, 2006
In the short run, the ruling upholds an injunction obtained by state Attorney General Bill Lockyer that prohibits Pearle Vision Inc., the optician subsidiary, from advertising eye exams, and allows Lockyer to continue a lawsuit filed in San Diego four years ago that challenges the company's relationships with VisionCare. But Lockyer's office and a private lawyer in a related suit said the case has broader implications. (San Francisco Chronicle -- Business)
HMO rates likely to rise a bit less Jun 14, 2006
Consultant predicts smaller gain in '07 Associated Press Originally published June 14, 2006 NEW YORK // Rate increases for health maintenance organizations (HMOs) are set to decline in 2007 for the fourth consecutive year, but still create challenges for employers, according to a report released yesterday. Preliminary figures show that HMO rates will rise about 11. (Sunspot.net -- Business)
A doctor shortage threatens to set off healthcare crisis Jun 5, 2006
One is that health maintenance organizations have not produced the expected drop in physician demand, in part because of a patient backlash against inadequate choices and denial of care. New technology also has not reduced the need for physicians as much as expected. (Boston Globe)
Poor Doctor Patient Communication Hinders Asthma Care May 24, 2006
However, when physicians are under pressure to see many patients in a relatively short time period, which is the case in some health maintenance organizations, conversations about asthma care may be rushed or incomplete, he suggested. The findings, from the Global Asthma Physician and Patient (GAPP) survey, involved nearly 3,500 adults and 16 countries. (MEDLINEplus)
Study: HMOs may be due for a rebound in Florida May 4, 2006
Though preferred provider organizations continue to show membership gains in Florida, many employers are returning to health maintenance organizations to control costs, according to a new study by. Six new HMOs were licensed in Florida last year, most of them for Medicare and Medicaid, according to Florida Health Plan Analysis. (Orlando Business Journal)
Patient satisfaction sometimes misplaced May 3, 2006
Researchers tracked 236 elderly patients being treated at two health maintenance organizations in the Northeast and Southwest, the New York Times reported. Dr. John Chang of the University of California at Los Angeles Medical School said that patients who rated their doctors as having poor communications skills also tended to rate the care they received as poor. (Washington Times)
Wooten: College costs, women who act up Apr 28, 2006
Getting beneficiaries of taxpayer-financed medical care into health maintenance organizations that will help them manage wellness is a major accomplishment for Gov. Sonny Perdue. As Dr. Phil might say: how well has what you were doing been working for you. (Atlanta Journal-Constitution)
State Medicaid Overhaul Could Require Special Session Apr 26, 2006
" The danger, she said, is that federal officials could make any number of changes to the proposal before approving it. "AARP has consistently opposed forcing seniors into managed care," she said. "But if the Legislature is going to move forward, we want them to see the full, approved waiver. " The Florida Association of Counties fully supports the project, lobbyist Heather Youmans said, but also thinks the Legislature should vet the final proposal. "We don't think we should rush into a pilot... (Tampa Bay Online, FL -- News)
Medicare deadline swamps insurers Apr 24, 2006
8 million in health maintenance organizations and 6. 8 million retirees with coverage from former employers. (The Morning Star)
Elderly warned of drug scheme Apr 20, 2006
The plan operates similar to health maintenance organizations and some do not pay for prescriptions. Medicare spokeswoman Lee Millman said the agency has not received any complaints but does not allow for any door-to-door marketing. (Enterprise-Journal)
Proskauer Hit With Malpractice Suits in Florida Apr 18, 2006
According to the complaint, Rosow approached Pearce in 1998 about investing in three health maintenance organizations that were consolidating into a larger health care company. Pearce retained Proskauer to evaluate the investment and perform due diligence for the proposed transaction. (Law.com)
Report: Claim processing big health complaint Mar 28, 2006
Still, health coverage firms and health maintenance organizations showed progress in several consumer areas. For example, there were fewer complaints about the ability to get access to medical specialists and care outside the patient's network. (Newsday)
Medical Safety Net Shrinks with Less Charity Care Mar 25, 2006
Doctors' financial predicament stems from a move away from a fee-for-service payment system toward health maintenance organizations, where insurers negotiate rates with large groups of doctors, Cunningham said. While many of the restrictions on care from HMOs have eased, "health plans are still vigorously negotiating payment rates with physicians," he said. (MEDLINEplus)
A Promising Prognosis for WellPoint Jan 10, 2006
OTHER SERVICES. The company's product portfolio includes a diversified mix of managed-care products, including health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point of service (POS) plans, as well as traditional indemnity products. WellPoint also offers administrative and managed-care services and partially insured products for employer self-funded plans, including underwriting, stop-loss insurance, actuarial services, provider network access, medical-cost... (BusinessWeek)
Business getting new allies on high court Jan 7, 2006
Roberts spent more than a decade with the private law firm of Hogan & Hartson, arguing on behalf of Toyota and health maintenance organizations. He wrote friend-of-the-court briefs for the U.S. Chamber of Commerce, participated in its moot court and earned its endorsement. (CNN -- Law)
Glitches likely in drug benefit Jan 2, 2006
In addition, insurers said some people happily receiving care in health maintenance organizations, under contract to Medicare, had signed up for free-standing prescription drug plans, not realizing that they would be automatically ejected from their HMOs. They now face higher costs for hospital care and doctor's visits in the traditional Medicare program. (Albany Times Union)
Medicare drug benefit Jan 1, 2006
Another 17 million have been signed up because they were automatically enrolled through employer pension plans, health maintenance organizations or because drug coverage through Medicaid, the state's insurance plan for the poor, is shifting to Medicare. Many people are concerned about those who were receiving their drugs for free through Medicaid before 2006. (Daytona Beach News Journal)
As New Drug Plan Begins, Stores Predict Bumps Jan 1, 2006
In addition, insurers said that some people happily receiving care in health maintenance organizations, under contract to Medicare, had signed up for free-standing prescription drug plans, not realizing that they would be automatically ejected from their H.M.O.'s. They now face higher costs for hospital care and doctor's visits in the traditional Medicare program. (New York Times)
