Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Managed Care. Show all posts
Showing posts with label Managed Care. Show all posts

Friday, March 3, 2017

California Regulator Slams Health Insurers Over Faulty Doctor Lists

Chad Terhune
Kaiser Health News
Originally published February 13, 2017

California’s biggest health insurers reported inaccurate information to the state on which doctors are in their networks, offering conflicting lists that differed by several thousand physicians, according to a new state report.

Shelley Rouillard, director of the California Department of Managed Health Care, said 36 of 40 health insurers she reviewed — including industry giants like Aetna and UnitedHealthcare — could face fines for failing to submit accurate data or comply with state rules.

Rouillard said she told health plan executives in a meeting last week that such widespread errors made it impossible for regulators to tell whether patients have timely access to care in accordance with state law.

“I told the CEOs it looks to me like nobody cared. We will be holding their feet to the fire on this,” Rouillard said in an interview with California Healthline. “I am frustrated with the health plans because the data we got was unacceptable. It was a mess.”

The article is here.

Monday, July 29, 2013

Kentucky’s Rush Into Medicaid Managed Care: A Cautionary Tale For Other States

By Jenni Bergal
Kaiser Health News, in conjunction with the Washington Post
Originally published July 15, 2013

Here is an excerpt

Ever since Kentucky rapidly shifted patients from traditional Medicaid to private health plans that manage their care for a set price, problems have been widespread.

Patients complain of being denied treatment or forced to travel long distances to find a doctor or hospital in their plan’s network. Advocates for the mentally ill argue the care system for them has deteriorated. And hospitals and doctors say health plans have denied or delayed payments.

Experts warn that what happened in Kentucky should be a cautionary tale for other states that rush to switch large numbers of people in Medicaid, the state-federal program for the poor and disabled, to managed care in hopes of cutting costs and improving quality. Nearly 30 million Americans on Medicaid now belong to a private health plan, as states move away from the traditional program that paid doctors and hospitals for each service they provided.

The entire story is here.

Wednesday, October 19, 2011

Barriers High in Mental Health Care

By Nancy Walsh
Staff Writer, MedPage Today

For mental health care, how bad are things, really?

That was the question posed by a group of physicians in Boston who had found difficulties in providing psychiatric referrals for their patients.

So they undertook a "simulated patient" study, telephoning all 64 Blue Cross Blue Shield in-network psychiatric facilities within 10 miles of the center of Boston, according to Rachel Nardin, MD, of the Cambridge Health Alliance in Cambridge, and colleagues.

This summary article can be found here.

The original article in the Annals of Emergency Medicine can be found here.

The article concludes:

"Although there are many contributors to the inadequacy of our mental health system, managed care has hit psychiatric services hard. Private insurers aggressively constrain patients' access to services by stringently limiting provider networks. As our study shows, this is often covert; insurers provide lists of in-network providers, but most are unavailable. Reimbursements for psychiatric services are far lower than for other types of care, so institutions frequently restrict access as stringently as possible, often, as in our study, by requiring that a patient have an in-system primary care provider (even though the insurer requires no referral). Many private practitioners refuse to accept insurance payments altogether. Improved reimbursements for psychiatric care will be an important step in reducing the barriers to care experienced by patients with severe depression."