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GLG News by Managed Care Experts

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March 20, 2008
No End To The Madness
Analysis of: House Moves Closer to Mental Health Bill | online.wsj.com
Author: GLG Expert Contributor
Mental health is undoubtedly a most important issue, but this is another instance of being backdoored into national healthcare.
March 19, 2008
A Short Term Pricing Problem
Analysis of: Health insurers take a dive on WellPoint's warning | www.marketwatch.com
Author: GLG Expert Contributor
1. Managed care companies have run into a temporary problem of setting their prices too low in order to compete with eachother. Expect prices to rise and profitability to return. 2. Part of the problem was caused by providers becoming more sophisticated at fighting for higher reimbursement often aided...
March 17, 2008
The Question "Can Health Plans Control Medical Costs" is antithetical...
Analysis of: Health insurers take a dive on WellPoint's warning | www.marketwatch.com
Author: GLG Expert Contributor
Health plans [insurers] cannot control healthcare costs: (1) it is not their role and purpose (2) they are not providers of medical services (3) they are subject to, and operate in, a mature market, and (4) they have been neutered by regulation and politics.      ...
Frederic GoldsteinMarch 13, 2008
WellPoint Disappoints, Cites Increased Medical Costs as One Reason
Analysis of: Health insurers take a dive on WellPoint's warning | www.marketwatch.com
Author: Frederic Goldstein, President and Chief Operating Officer, U.S. Preventive Medicine, Inc.
Health Plans are going to have to radically change their systems and approaches if they expect to improve their success in the long run.  The system as currently structured dis-incents Health Plans from doing the right thing, actually managing health.  This requires a long term commitment...
March 7, 2008
Marsh, Aon, Willis, Gallagher, Acordia, Zurich, Ace and all big brokerage houses hard pressed to beat earnings
Analysis of: MMC Sees 4Q Net Income Drop 62% | www.propertyandcasualtyinsurancenews.com
Author: GLG Expert Contributor
The reason Marsh is struggling is because of poor leadership ending up with $850,000,000+ in fines from NY, IL and CT for bid rigging and prohibited contingency fees.  Future profitability & growth for these brokerages is anything but certain and likely to grow very slowly because they are...
March 4, 2008
Rewarding Doctors Good Medicine to Beat Earning Forcasts
Analysis of: Managed-care company sees benefits of pay-for-performance | www.tennessean.com
Author: GLG Expert Contributor
The plans that figure out how to get doctors to self manage best of breed chronic care will certainly spend less money treating their insured lives.  For example, preventing a colon cancer, cervical cancer, heart bypass, transplants, premature infant, stroke or MI saves big bucks.  It saves...
March 3, 2008
What are the goals of Pay for Performance?
Analysis of: Managed-care company sees benefits of pay-for-performance | www.tennessean.com
Author: GLG Expert Contributor
1. Pay for performance is designed to incentivize certain provider performance. It does not actually pay for achieving better health by a population. 2. Pay for performance incentivizes certain patterns of utilization of care. These patterns may actually create additional costs. For example, encouraging...
February 29, 2008
Anesthesiologists' Reimbursement is of Concern to Payors
Analysis of: Aetna to Delay Reduced Colonoscopy Coverage | online.wsj.com
Author: GLG Expert Contributor
When a member seeks medical care from a participating provider in their HealthPlan, they try to select a contracted specialist and a contracted hospital.  Usually a member does not select the Anesthesiologist, because they usually don't even think of this provider treating them.   HealthPlans...
February 29, 2008
Factors to Consider in Implementing Pay for Performance Programs.
Analysis of: Managed-care company sees benefits of pay-for-performance | www.tennessean.com
Author: GLG Expert Contributor
The life of a member with a managed care plan may only be 12 months and then their employer may  select another Payor.  In tracking the progress of a member's health, there is a delay of at least 90 days to capture the claims data.  Analyzing the data for a true improvement...
Frederic GoldsteinFebruary 29, 2008
Pay for Performance Can Drive Physician Behavior, but don't Forget the Patient
Analysis of: Managed-care company sees benefits of pay-for-performance | www.tennessean.com
Author: Frederic Goldstein, President and Chief Operating Officer, U.S. Preventive Medicine, Inc.
Using appropriate Pay for Performance programs can drive physician behavior and results in changes in utilization, these should be continued but the patient component is a larger issue.    

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