Medicine Card The Discovery Of Power Through The Ways Of Animal

4 pages. Excerpt: "This issue of our 2008 Perspectives series looks at how Hannaford Supermarkets used a 'quality paradigm' -- focusing on quality care, efficiency, evidence-based medicine and cost control to dramatically lower its health care spend while lifting employee satisfaction and perception of quality." (Towers Perrin)

Excerpt: "Bernadine Healy, MD, former director of NIH and now health editor at US News & World Report, has written a chilling piece on how easy it is for insurers to deny claims. From the article, 'How Crafty Health Insurers Are Denying Care' . . . ." (Health Insurance Consumer Information)

Excerpt: "Increasing healthcare costs and an influx of expensive drugs and tests, combined with an aging population, set off a healthcare crisis in the United States. Contending with soaring costs, insurers changed the business of health care by requiring preauthorizations, mandating cheaper drugs, and tightening controls on treatment decisions. But among the first casualties of these changes, many physicians said, was the doctor-patient relationship." (Toledo Blade)

As the proposed merger between two Pennsylvania Blue Cross Blue Shield-affiliated plans comes closer to resolution, the answer to one question could determine its approval or rejection: What is a market?

Whether nonprofits Independence Blue Cross and Highmark Inc. are allowed to combine could come down to which perspective regulators believe is more germane: the distinct local markets each Blues plan works in now, or the regional and national markets in which the combined plan wishes to compete.

The merger would create one of the largest health plans in the country, with 7 million lives covered and an estimated $22 billion in annual operating revenue. It would be the third-largest health plan in the country, measured by premiums collected.

By some estimates, the combined company would hold more than 70% of the commercial health insurance market in Pennsylvania by combining Highmark's market share in western Pennsylvania with Independence's share in the eastern part of the state.

The Pennsylvania Medical Society and the American Medical Association are among those arguing that a combined company would hold far too much market dominance in the state. But the health plans say they currently don't overlap in Pennsylvania, so the market share effectively does not change. The companies also argue that they need to get bigger to compete for national business against the nation's largest for-profit plans, as more health insurers try to sell themselves as being able to handle a corporation's health coverage everywhere it is located.

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The virtual physician visit is becoming a reality.

Companies that promise patients the chance to see a physician through video linkups are pushing into the mainstream. One is making it possible for anyone in the state of Hawaii to talk to a doctor of his or her choice via a webcam -- in a visit that could be reimbursed by the patient's health plan.

Meanwhile, in an effort to cut costs, a chain of retail clinics in Houston has replaced in-person visits to a nurse practitioner with online, webcam-enabled visits with doctors across town.

Telemedicine started as a way to remove access barriers. But it is now driven by people who value the convenience it offers, said Joseph Kvedar, MD, director of the Center for Connected Health, a Boston-based nonprofit group, affiliated with Partners HealthCare, whose stated mission is to expand the availability of medical care outside traditional settings.

The improved quality of the technology, the scale of adoption and the idea of health plans reimbursing for those visits have the potential to be game-changing, experts say. Proponents of telemedicine don't believe it will ever replace traditional practice-based care, but they do see it as a way to ease the load for busy physicians and overcrowded emergency departments, Dr. Kvedar said.

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