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Calif. hospital, docs plan ACO with Blue Shield
Modern Healthcare

Hoag Memorial Hospital Presbyterian, Newport Beach, Calif., and Greater Newport Physicians have agreed to form an accountable care organization with Blue Shield of California. The three-year accountable-care agreement must be approved by the California Department of Managed Health Care, according to a Blue Shield of California news release. Healthcare costs for roughly 11,000 managed-care enrollees will remain largely flat during the first year, which will begin July 1, to be followed by “low single-digit increases,” according to the release.

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More Americans seeking dental treatment at the ER
USA Today

More Americans are turning to the emergency room for routine dental problems — a choice that often costs 10 times more than preventive care and offers far fewer treatment options than a dentist’s office, according to an analysis of government data and dental research. Most of those emergency visits involve trouble such as toothaches that could have been avoided with regular checkups but went untreated, in many cases because of a shortage of dentists, particularly those willing to treat Medicaid patients, the analysis said.

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Proposed new EHR certification rules released
Modern Healthcare

While most of the attention in the health information technology industry last week was focused on the newly proposed Stage 2 standards that providers would have to meet to achieve meaningful use of electronic health-record systems, a companion proposed rule affecting EHR vendors and the organizations that test and certify them also was made public.

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Autism not diagnosed as early in minority children
USA Today

Early diagnosis is considered key for autism, but minority children tend to be diagnosed later than white children. Some new work is beginning to try to uncover why — and to raise awareness of the warning signs so more parents know they can seek help even for a toddler. “The biggest thing I want parents to know is we can do something about it to help your child,” says Dr. Rebecca Landa, autism director at Baltimore’s Kennedy Krieger Institute, who is exploring the barriers that different populations face in getting that help.

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Hospital’s mission: self-promotion
RecordNet

California’s oldest public hospital is embarking on a new venture: creating a nonprofit, independent foundation to increase community awareness of its services and raise funds to support its mission.

Part of that mission for San Joaquin General Hospital is “the delivery of community-oriented, culturally sensitive and affordable health care throughout San Joaquin County.”

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Health Net, Cigna Make Deal with California on Autism Benefits
LifeHealthPRO

Two large health insurers, Cigna Corp. (NYSE:CI) and Health Net Inc. (NYSE:HNT), have agreed to cover applied behavioral analysis (ABA) therapy and similar therapies for California residents with autism whenever a behavioral therapy approach is found to be medically necessary.

Cigna, Bloomfield, Conn., and Health Net, Woodland Hills, Calif., made the deal with California Insurance Commissioner Dave Jones.

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Cancer’s growing burden: the high cost of care
USA Today

Patti Tyree was afraid that cancer would steal her future. Instead, the cost of treating it has. She had hoped to buy a small farm with money inherited from her mother. But copayments for just one $18,000 round of breast chemotherapy and one shot of a nearly $15,000 blood-boosting drug cost her $2,000. Bills for other treatments are still coming, and almost half of her $25,000 inheritance is gone.

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California orders Kaiser to stop denying physical, occupational and speech therapy to certain patients
Contra Costa Times

State regulators on Monday ordered Kaiser Foundation Health Plan to stop denying physical, occupational and speech therapy to certain patients. Kaiser has declined such therapy to members who lack a “physical condition,” according to documents filed by the state Department of Managed Health Care. That means that people who may stutter or lisp or who have developmental delays don’t receive speech therapy, for example, said Anthony Manzanetti, chief of enforcement for the state agency.

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Two insurers agree to cover autism treatment
Orange County Register

Two more insurers have reached settlements to provide autism treatment after consumer complaints about denial of coverage to California’s Department of Insurance. Health Net and Cigna struck agreements with the state after Blue Shield last month agreed to cover a treatment known as applied behavior analysis, which is used to teach skills such as listening, imitating and seeing the perspective of others.

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Hoag launches new affordable care joint initiative
OC Metro

Hoag Memorial Hospital Presbyterian in Newport Beach has undertaken a new coordinated care model in partnership with Blue Shield of California and Greater Newport Physicians. The three-year accountable care initiative aims to provide approximately 11,000 Blue Shield HMO policy members in Orange County with integrated, cost-efficient healthcare.

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Tenet says delayed payments from insurers hit results
Imperial Valley Press Online

Tenet Healthcare Inc on Tuesday said delayed reimbursements from some insurers caused it to report quarterly earnings below analyst estimates but the No. 3 U.S. hospital chain raised its full-year outlook because it expects to be paid later in the year.

Opinion/Editorial

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Who else is paying your doctor?
USA Today

When you get a prescription from your doctor, you shouldn’t have to wonder whether his or her decision was influenced by payments from the drug’s maker. But little by little, small-bore favors such as free samples, promotional trinkets, tickets to sporting events, and deli trays delivered to the office have evolved into practices that look more like outright bribes.

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Consider hospital alliance
Monterey Herald

Having spent the majority of the past 40 years in the health care field, I was disappointed by the thrust of Sunday’s Herald editorial. While I, too, support transparency in public policymaking, the notion that the community should have a direct role in determining the future organizational structure of the Salinas Valley Memorial Healthcare System (SVMH) strikes me as naive.

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Physician Payments Sunshine Act’s expensive
USA Today

Supporters of the Physician Payments Sunshine Act failed to take into account how expensive “sunshine” would be. Requiring drug and medical device manufacturers to publicly report virtually every payment they make to physicians, physician groups and teaching hospitals will end up costing far more than the $224 million estimated for just the first year of compliance. The biggest cost will be the valuable, socially useful physician-industry collaborations that simply won’t occur.

Blogs

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Autism in California: Major Health Insurers agree to provide autism coverage
San Francisco Chronicle

Great news. Insurance Commissioner Dave Jones announced today that he has reached favorable settlement agreements with two major health insurers, Health Net and Cigna, to guarantee coverage of behavioral therapy for autism, and to provide it to all insureds whenever medically necessary. The two new settlement agreements follow a similar settlement agreement reached last month with Blue Shield to provide behavioral health treatments, including Applied Behavior Analysis Therapy (ABA), a well-recognized and effective treatment for autism.

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Gov. meets with congressional delegation, still hopeful on Medi-Cal
Los Angeles Times

Gov. Jerry Brown on Monday sounded still hopeful of gaining federal approval for more flexibility in administering the Medi-Cal health insurance program for the poor, even after having been rebuffed by the Obama administration. “There are possibilities that are being examined that will enable California to more tightly manage its Medi-Cal program,” the governor said at the U.S. Capitol after meeting behind closed doors with a rare bipartisan gathering of California’s congressional delegation.

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Jerry Brown presses Obama on Medi-Cal, meets with labor
Sacramento Bee

Gov. Jerry Brown continued to press President Barack Obama today for authorization to enact further cuts to Medi-Cal to help balance California’s budget, even as the administration showed no sign of relenting and complained about the severity of state budget cuts in other areas. Obama told governors in a meeting this morning that too many states are cutting education programs too deeply, citing teacher layoffs and rising college tuition.

  

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