Monday, April 13, 2009

Monday Musings

  • Business Insurance reports that health insurers are facing earning challenges.
    Major U.S. health insurers and managed care companies earned sharply lower profits in 2008, some nearly half of 2007 results, as poor stock market performance and lower interest rates chiseled away at their investment portfolios.
    The New York Times reports that a sign of these times is Wellpoint's decision to sell its prescription benefit management operation to the independent PBM Express Scripts for $4.7 billion. According to that report,

    When WellPoint put the business up for sale several months ago, the bidding quickly grew heated as the three larger benefit managers fought to buy the unit.

    With the deal, Express Scripts is able to claim a victory over CVS. Nearly two and a half years ago, the two companies were locked in a takeover battle to acquire Caremark Pharmacy Services.

    Reuters offers five facts about PBMs including
    The four largest PBMs last year in terms of prescriptions were Medco (796 million), CVS Caremark (742 million) (CVS.N), Express Scripts (506 million) and NextRx (268 million).

    * Aside from WellPoint, other health insurers that operate PBMs include UnitedHealth Group (UNH.N), Aetna (AET.N) and Cigna (CI.N).
  • I found a number of articles about efforts to increase the convenience of obtaining health care services. CNN writes about the growing use of retail clinics found in pharmacies and discount stores. The AP reports that "From New York to Los Angeles to St. Louis, health workers are going to barbershops, long a gathering place for black men, to provide screenings to those who may not get regular checkups." The Minnesota Star Tribune reports about a Blue Cross Blue Shield pilot "to offer its 10,000 employees and dependents the chance to use a 'virtual clinic,' an Internet site that can connect them with a doctor for a live 10-minute consultation for a flat fee." The virtual clinic is a product of American Well. Finally, the Boston Globe reports on a personal health record goof on Google Health that occurred because health insurance records were confused for medical records. There is always a limit to convenience.

  • Health Leaders media reports on the relatively mild reaction of hospital compliance officers to the ARRA amendments to the HIPAA privacy and security rules. (I consider many of these changes to be nuts.) Interestingly, according to this report,
    some providers told us they’re more worried about the Red Flags Rule deadline—May 1. Hospitals considered to be creditors must set up a policy and procedure that helps them identify "red flags" on identity theft, prevents them and corrects them through self-audits (the FTC last week came out with some nice guidance to help comply).
    I learned from this week's AMA News that the AMA is apoplectic about these new FTC anti-identity theft rules.

  • The Senate Commerce Committee has posted a copy of the letter that Chairman Jay Rockefeller sent 18 health insurers about their use of the Ingenix usual reasonable and customary databases. A copy of that letter is here.

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