AIS's Health Business Daily
Strategic Business News from Experienced Health Care Reporters
at Atlantic Information Services, Inc.
ACO Business News
Today’s issue is brought to you by ACO Business News, a hard-hitting monthly newsletter on the latest industry actions to design and create ACOs, for hospitals, physicians, health plans and their advisers.

September 16, 2014

Today's Featured Story

Pediatrics Have a Place in Accountable Care Organizations, but Adult Medicine Still Is the Primary Focus
Reprinted from ACO Business News

Orange County, Calif.-based St. Joseph Hoag Health and CHOC Children’s say they have agreed to put together an accountable care organization that will focus both on adult and pediatric care issues in pacts with commercial insurers. However, ACO insiders say the deal between the two organizations doesn’t herald a new role for children’s hospitals in ACOs or a new focus on pediatric care management for ACOs. Most ACOs, even commercial ones, still will find their biggest return on investment in programs aimed at adults, not children.... Read Full Story


Quote of the Day

“I would expect premium rates to increase possibly through 2020. While the jury is still out on whether enough ‘young invincibles’ are enrolling to subsidize high-cost enrollees, other factors like enrichment of benefits, phase-out of the reinsurance program, and continuing phase-in of the health insurance provider fee (i.e., tax) will require ongoing rate increases. Cost trend will certainly also be a factor, and will add to increases discussed in the prior sentence on a percentage point-by-point basis.”

— Brian Weible, vice president and actuary at Wakely Consulting Group, told AIS’s Health Plan Week in an exclusive interview.

Click here to read the HEALTH PLAN WEEK article in which this quote appeared. (Free for HPW subscribers; $17 for non-subscribers).


Today's Datapoint

68% ... of the a hospital’s net amount of appeals for denied Medicare claims (for inpatient admissions) is being offered by CMS to hospitals that opt to discontinue all of these appeals, in a unique effort by the agency to reduce its enormous backlog of Medicare appeals.

Click here to read the REPORT ON MEDICARE COMPLIANCE article in which this datapoint appeared. (Free for RMC subscribers; $17 for non-subscribers).


FierceHealthPayer News from our partner FierceMarkets

Medical tourism gains popularity with health insurers

Cost challenges under healthcare reform have caused major U.S. health insurers to jump onto the medical tourism trend. Some uninsured or underinsured Americans already travel overseas for bargain priced elective procedures and treatments. Now UnitedHealth Group, WellPoint and Humana are looking to curb expenses by encouraging their members to receive medical tourism procedures abroad through cross-border plans, Medical Tourism Magazine reported.... Read more


Today from Washington

People on the Move

Louis Silverman was appointed to STAAR Surgical Company’s board of directors. He is currently the chairman and CEO of Advanced ICU Care, Inc.Purdue Pharma L.P. named Susie Robinson vice president of human resources. She was previously head of human resources at Lumeris….The Society for Cardiovascular Angiography and Intervention (SCAI) appointed Lisa Olson executive director. She was most recently the founder of aha Group.


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