News in brief - June 19, 2000

Highmark delays specialty capitation - Cigna dropping Medicare - PPO enrollment tops HMOs - On-call services deemed underpaid - Employers pay most of premium hike - Many patients switch coverage - Rising small business coverage - Educated complain most about HMOs - Anthem purchase of Maine Blues OK'd

Highmark delays specialty capitation

Highmark Blue Cross Blue Shield in Pittsburgh said it will postpone start-up of its controversial "episodic care" payment plan for specialists from July 1 until next year.

The company said state officials want further information on how the proposal would impact quality of care and availability of specialists.

Highmark's efforts were detailed in a recent article (AMNews, May 15 ).

Cigna dropping Medicare

Citing losses in its Medicare business, Cigna Healthcare says it will drop all Medicare HMOs except those in Albuquerque, N.M., and Phoenix by Jan. 1, 2001.

The decision affects 104,000 Medicare beneficiaries in the Baltimore-Washington, D.C., area, New York City area, Atlanta, Houston, Los Angeles, Orlando, Fla., and Tampa, Fla.

PPO enrollment tops HMOs

PPOs now claim 50% of the commercial market compared with HMOs' 40% share, according to InterStudy Publications, a managed care research firm in St. Paul, Minn.

On-call services deemed underpaid

Just over half of physicians responding to a California Medical Assn. survey said that typically they don't get paid for care of insured patients while on hospital call.

Another 42% said that they are usually paid, but it is less than the billed amount or is delayed. Almost a third said they have ceased or reduced on-call services because of payment difficulties.

Employers pay most of premium hike

Employer-sponsored health plans are shouldering a greater burden of prescription drug costs today than five years ago, according to a new study of prescription drug records by pharmacy benefits manager Merck-Medco.

The study found that the average drug cost per patient for employer plans has jumped from $237.97 in 1995 to $506.72.

Many patients switch coverage

A study by the Center for Studying Health System Change found that 17% of consumers switched their health plans between 1996 and 1997.

Two-thirds cited reasons other than personal preference, such as employers changing plan offerings or individuals switching jobs.

Rising small business coverage

Dun & Bradstreet says 54% of small businesses now offer health insurance, up from 40% last year. But 74% of respondents said premiums also have increased.

Educated complain most about HMOs

New Jersey HMO members with college degrees are twice as likely as high school dropouts to be dissatisfied with HMOs, according to a recent study by Rutgers University and the NewJersey health department.

Anthem purchase of Maine Blues OK'd

Maine officials have approved the purchase of Blue Cross Blue Shield of Maine by Indianapolis-based Anthem Blue Cross Blue Shield for $120 million. A new charitable health care foundation in the state will get $80 million of that money.

The state approved the move despite the objections of the Maine Medical Assn., which is concerned that Anthem might eventually exit the state.