Managed Care Report
Managed Care Report
• PacifiCare Health Systems (Santa Ana, CA), which recently agreed to purchase the Texas HMO Harris Methodist Health Plan, said last week that it intends to sharply reduce Harris’ operations in Arlington, TX, where 950 people work for Harris, reported the Fort Worth Star-Telegram. PacifiCare’s stategy to turn around the ailing HMO includes broad cuts in administrative, medical, and pharmaceutical expenses, and it hinges on Harris adding reserves to the plan before the deal closes, the Star-Telegram reported. PacifiCare did not say how many people would lose their jobs, saying that decision would probably not be made for at least a month.
• Tennessee Gov. Don Sundquist announced last week a plan to reform TennCare, the health insurance plan for low-income and uninsured people in Tennessee. With the plan, Sundquist wants to roll back benefits for prescription drugs and home healthcare to what was offered under Medicaid before TennCare began six years ago. Beginning in January, TennCare will pay for only seven prescriptions a month and 60 home health visits a year, reported the Chattanooga Times/Free Press. The changes are part of a 12-part plan to nurse the $4.3 billion-a-year TennCare program back to fiscal health by limiting enrollment to those who are not Medicaid eligible and by asking recipients to pay more of their healthcare bills.
• UnitedHealth Group scored a major public relations coup this month when it declared an end to doctors having to get referrals from HMOs for most procedures, reported the Dallas Morning News. Doctors’ groups and consumer advocates say they expect a sharp decline in the hassles they face when trying to arrange care. And several large insurers are studying similar actions, the Morning News reported.
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