News in brief - Feb. 14, 2011

Guardian leaves medical benefits business

Citing lack of scale to be effective in the group medical insurance business, Guardian Life Insurance is leaving the industry.

Spokesman Richard Jones said the company had 44,340 covered workers with 1,700 employer customers when it decided to stop selling group medical coverage. He said the company will continue to offer dental and disability insurance.

"The medical marketplace has really become dominated by the large national carriers," Jones said. "It's really because it's not anywhere we feel we can compete effectively." He said Guardian had been using a rental network.

United Healthcare will have first crack at offering medical insurance to Guardian's remaining customers when they look for coverage in 2012, Guardian said.

Back to top

Blue Shield agrees to delay rate increase

After a few weeks of declining to agree to California Insurance Commissioner Dave Jones' request to delay its rate increase, Blue Shield of California conceded Feb. 1. The health plan agreed to put off its most recent rate increase, set to kick in March 1, for at least 60 days.

The company previously announced that it would ask an independent actuary to review its rate increase filing to ensure that it would comply with state law.

With the pending hike, some policyholders were set to see a cumulative increase of 59% over the last year. Anthem Blue Cross of California, Aetna and UnitedHealth Group subsidiary PacifiCare were asked to delay their pending increases to allow time for state review. The companies agreed to do so.

Back to top

Specialists form Maine's largest IPA

Four physician groups announced Jan. 26 the formation of Maine Specialty IPA. With more than 250 physicians affiliated with Chest Medicine Associates, Portland Gastroenterology Associates, OA Centers for Orthopaedics and Spectrum Medical Group taking part, the independent practice association is the largest of its kind in the state.

The goal is to reduce administrative costs and improve contracting with insurers while maintaining independence.

"Collectively, we believe that by aligning and integrating, our groups will be able to improve clinical care coordination and delivery of specialty medical services for the benefit of our patients," said pulmonologist Robert McArdle, DO, president of Chest Medicine Associates in South Portland, Maine. "Simultaneously, we expect to improve efficiency and address the overall costs of health care services in a positive manner."

The organization is limited to the founding members, but the intention is to expand to include other practices.

The move comes as hospital employment of physicians is rising in Maine. About 15% of the state's physicians were employed by a hospital or federally qualified health center a decade ago, according to the Maine Medical Assn. That number has grown to 70%.

Back to top

Final certification rules passed

The Office of the National Coordinator for Health Information Technology announced in January that it passed the final regulation for establishing a permanent certification program for electronic medical record systems being used to qualify for meaningful use incentives. It plans to complete the additional steps necessary to put those rules into place during the next year.

The regulations will replace the temporary program established in June 2010 to give health care organizations the chance to get a jump start on qualifying for incentives. That temporary program will remain in effect at least until its sunset date of Dec. 31, 2011.

All physicians hoping to qualify for the Centers for Medicare & Medicaid's meaningful use incentive program must adopt an EMR that has been certified by an ONC-authorized certifying body. Those organizations will have to reapply for authorization to test under the final rules.

This content was published online only.

Back to top