News in brief - June 5, 2000

Drug costs climbing - Direct contractor considers offer - N.J. unveils HMO grievance guidelines - U.S. health care costlier Colo. Blues lose members, make money

Drug costs climbing

Prescription drug expenditures jumped 25% a year between 1996 and 1999, according to a study released May 10 by RxHealthValue, a coalition of the AFL-CIO, AARP, BlueCross BlueShield Assn. and 27 other groups. That number is higher than Health Care Financing Administration statistics, due to differences in sample size and study methodology.

Direct contractor considers offer

The Buyers Health Care Action Group in St. Paul, Minn., said May 15 that it is considering an offer from an unidentified company that would take over management of the coalition's Choice Plus health plan and possibly replicate the plan's direct contracting model in other markets, such as California, Oregon and Colorado.

N.J. unveils HMO grievance guidelines

New Jersey Gov. Christine Todd Whitman proposed the creation of an internal and external appeals process for resolving payment disputes such as arbitrary downcoding and payment delays and denials. The process would entail third-party arbitration for unresolved grievances.

The rules were prompted by physician complaints over inadequate enforcement of New Jersey's prompt-payment law, which requires HMOs to pay clean electronic claims within 30 days and paper claims within 40 days.

U.S. health care costlier

Health care costs in the United States are double health expenditures in other industrialized countries, but it is not clear whether U.S. citizens have better health care as a result, according to a report in the May/June issue of Health Affairs.

U.S. health care costs $4,270 per person, compared with $2,000 per person in countries of the Organization for Economic Cooperation and Development. But the United States ranks in the bottom half of OECD countries for life expectancy and infant mortality. However, U.S. patients are treated sooner than those in other countries.

Colo. Blues lose members, make money

Blue Cross Blue Shield's HMO Colorado lost 10% of its members in the first quarter of 2000 but still turned a profit under its new owner, Indianapolis-based Anthem Inc.

Meanwhile, the state's largest health maintenance organization, PacifiCare of Colorado, continued to lose money, according to first-quarter statements filed with the Colorado Division of Insurance.