The following are the latest issues that occurred between hospitals, health systems and payers within the past month, starting with the most recent.
1. Mercy Health, Michigan Blues Partner on Health Insurance Exchange Plan
Mercy Health, a four-hospital system based in Grand Rapids, Mich., partnered with Blue Care Network of Michigan to offer new, cheaper health plans to local residents on the state's health insurance marketplace.
2. Can Employer Caps Lower Hospital Prices? In California, Yes
Hoping to tamp down hospital charges, the California Public Employees' Retirement System, known as CalPERS, partnered with Anthem Blue Cross of California and its parent, WellPoint, to pilot a $30,000 maximum reimbursement rate for hip and knee replacements for some employees. The change shrunk WellPoint's average payment for the joint replacements in California by almost $7,000 to $28,695, which could save $5.5 million over two years for CalPERS and the state taxpayers who fund it.
3. AMA Rates Health Insurers on Timeliness, Accuracy
The American Medical Association's latest National Health Insurer Report Card found Cigna was the least administratively burdensome health insurer, costing 47 percent less per claim in erroneous administrative costs. Health Care Service Corp. had the highest administrative burden. Cigna also had the fewest claims denials at 0.54 percent. Humana had the fastest response time to appeals, inquiries and reconciliations with a six-day median response time. Aetna trailed behind at 14 days to respond.
4. Prime Healthcare Inks Contract With L.A. Care
Ontario, Calif.-based Prime Healthcare Services signed a contract agreement with L.A. Care Health Plan, the largest public health plan in the country.
5. West Penn Allegheny Discloses Closed SEC Investigation, $34.6M Loss
Pittsburgh-based West Penn Allegheny Health System, part of health insurer Highmark's Allegheny Health Network, released its third-quarter financial documents, which showed the health system had a net loss of $34.6 million, up from a loss of $19.8 million in the third quarter of its 2012 fiscal year.
6. Catholic Health Partners to Acquire Kaiser's Ohio Health Plan
Cincinnati-based Catholic Health Partners reached a tentative agreement to acquire Kaiser Foundation Health Plan of Ohio and its related multispecialty physician group, Ohio Permanente Medical Group.
More Articles on Hospital-Payer Relationships:
Drs. Donald Berwick, John Toussaint: Medicare Claims Data Should Be More Accessible
MedPAC Urges Congress to Close Pay Gap Between Hospitals, Clinics
4 Exclusion, Restriction Questions for Managed Care Contract Negotiations