health insurers

Non-profit health plans question for-profit switch by Horizon

Anne Zieger — Tue, 02 Sep 2008 22:16:58 -0400

A group of not-for-profit health insurers and providers have their back up over Horizon Blue Cross and Blue Shield's application to convert its corporate structure to for-profit status. The group, the Alliance for Advancing Non-profit Healthcare, contends that Horizon hasn't given a good enough reason to justify the conversion.

In its filing with the state, Horizon has said that switching from not-for-profit to for-profit operations will help it obtain greater access to capital, which it plans to invest in information technology, pay-for-performance initiatives and business operations. These investments would exceed the plan's annual $35 million by a projected $20 million, to $30 million per year during the next five years.

However, the Alliance, whose members include Henry Ford Health System, Minnesota Blue Cross Blue Shield, Provena Health and the Washington State Hospital Association, isn't buying Horizon's pitch. Its leaders have sent letters to both the New Jersey attorney general and commission of the Insurance and Banking Department, urging them both to closely study Horizon's application. The Alliance's leaders say the officials should question why Horizon can't get the capital it wants while staying a not-for-profit entity.

To learn more about the challenge:
- read this Modern Healthcare article

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SPOTLIGHT: Health insurers bearing down on imaging costs

Anne Zieger — Tue, 29 Jul 2008 01:49:45 -0400

First, the indefatigable Sen. Chuck Grassley (R-IA) says he's introducing a bill that could potentially slow down the delivery of imaging services to Medicare patients. Now, health insurers are scrambling to justify their programs limiting the use of imaging, which have become a steadily larger issue as volumes of imaging studies have climbed. According to the Wall Street Journal's Health Blog, why, all they want to do is lend a helping hand to make sure the imaging is necessary. Imaging providers and some doctors beg to differ, however. Blog

Insurer troubles could mean more bad debt for providers

Wed, 30 Apr 2008 06:59:58 -0400

In recent weeks, health insurers have started announcing financial results, and the news hasn't been good. WellPoint, for example, saw profits fall 25 percent, and UnitedHealth Group recently lowered its 2008 profit outlook by 40 cents per share. With insurers feeling financial pain, they're likely to raise premiums next year. In response, companies are likely to ask employees to carry more healthcare costs, industry watchers say. The net effect of all of this buck-passing is that with consumers facing higher bills, providers are likely to face high levels of bad debt, financial analysts predict. That's the case, in part, because consumers will be facing not only higher bills, but also a tougher economy and challenging job market, both of which further limit their ability to pay down medical debt. Add that to confusion over the use of the National Provider Identifier on Medicare claims--which could slow payments substantially--and 2009 is shaping up to be a very difficult year for providers, especially hospitals, healthcare analysts warn.

To learn more about this trend:
- read this InsideARM piece

Related Articles:
In 2007, bad debt rising for hospitals
HCA sees debt rising until patients get insured