Guest guest Posted October 29, 2011 Report Share Posted October 29, 2011 Your Daily Posterous Spaces Update October 29th, 2011 Push for Health-Cost Data <http://ptmanagerblog.com/push-for-health-cost-data> Posted about 22 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=77595841> By ANNA WILDE MATHEWS<http://online.wsj.com/article/SB1000142405297020391180457665328282320885\ 2.html#> As employers rush to reduce their health-coverage expenses, they've created a new pressure point with health insurers. At issue: Just how much information employers can provide to workers about the cost of medical care. With employers pushing for pricing transparency, several major insurers are scrambling to upgrade their Web-based services to provide better details about costs. In addition, outside companies including Castlight Health Inc., Thomson Reuters<http://online.wsj.com/article/SB1000142405297020391180457665328282320885\ 2.html#>Corp., change:healthcare Inc. and CareOperative LLC's Healthcare Blue Book are competing to offer their own online price tools to employers. [image: PRICETOOL] The Augusta Chronicle/Zuma Press Pricing tools could help patients compare procedures like mammograms. The issue is arising because of a major shift in health-insurance plan design: More and more Americans have high-deductible insurance that requires them to pay cash out of pocket before coverage kicks in. These consumers are spending their own money on services such as imaging tests, so they want to shop around, just as they do when they buy a flat-screen TV. The idea is that if workers can compare the prices of, say, a colonoscopy or mammogram across various doctors, they may choose less costly care. But Web services that reveal health-care pricing typically have to be built using data that are collected by the health insurers, which are generally the ones processing medical bills for an employer's workers. Some, such as Aetna<http://online.wsj.com/article/SB10001424052970203911804576653282823208852.\ html#>Inc. and Cigna<http://online.wsj.com/article/SB10001424052970203911804576653282823208852.\ html#>Corp., are sharing at least certain information with third-party firms when clients ask them to do so. In other cases, according to benefits consultants, vendors and employers, insurers are declining to let the information be handed over to the outside companies. Denny Darrow, chief of staff at the Indiana state personnel department, said state officials want to hire a vendor to create a pricing tool for the approximately 26,000 workers the state covers. Like other big employers, the state is self-insured, so it essentially pays its own bills and uses a health plan mostly for administrative tasks and its provider network. But WellPoint <http://online.wsj.com/article/SB10001424052970203911804576653282823208852.html#\ >Inc. is declining to let him provide billing-claims data to two outside vendors the state wants to test, an action that requires the health plan's permission under his contract, he said. [image: [PRICETOOL]] WellPoint is " basically telling us, as a customer, you don't own the data you pay for, " said Mr. Darrow, who said the situation has been " frustrating. " WellPoint said it will " routinely share claims data with our customers and many of their vendors, except in areas where doing so would break our contractual obligations to our providers. " The company said most of its customers who are pushing for better pricing information are " focused on an integrated approach through WellPoint " and less than 0.25% of its clients have asked it to share data with an outside pricing-tool vendor. Indeed, part of the hang-up is that health plans' contracts with medical providers sometimes require pricing details to be kept under wraps. " There's a strategic advantage to both sides to maintaining confidentiality around pricing, " said Chas Roades, chief research officer at the Advisory Board<http://online.wsj.com/article/SB10001424052970203911804576653282823208852.\ html#>Co., a health-care research firm. A hospital may not want a low rate granted to one health plan in a negotiation to be known to rival insurers, and vice versa, he said. Insurers say only a tiny share of companies are interested in the outside vendors, which must be paid for their tools, while the insurers' offerings would typically be wrapped into services at no additional charge. Still, they tend to be large employers. General Electric<http://online.wsj.com/article/SB100014240529702039118045766532828232088\ 52.html#>Co. is using a Web tool based on the Thomson Reuters service, while grocery-store operators Safeway<http://online.wsj.com/article/SB1000142405297020391180457665328282320885\ 2.html#>Inc. and Delhaize America, a unit of the Belgian Delhaize Group<http://online.wsj.com/article/SB10001424052970203911804576653282823208852.\ html#>that owns chains including Food Lion and Hannaford, have worked with Castlight. Aetna said it also makes clients pay it to supply data to outside vendors. Randall Abbott, a senior consulting leader at Towers , said there have been " at least several dozen situations " among his firm's clients where employers' talks with various third-party vendors " hit roadblocks based on the health plan's position. " Insurers are promoting the idea that their data make their own tools highly accurate. WellPoint said it plans to offer pricing and quality information on 103 outpatient procedures by provider next year, including calculating out-of-pocket costs. UnitedHealth<http://online.wsj.com/article/SB10001424052970203911804576653282823\ 208852.html#>Group Inc. said that early next year it will provide pricing estimates and quality information for 125 doctor, lab, radiology and outpatient services, by provider, while it plans to add some inpatient services later in the year. Cigna said that by the end of the year it plans to offer pricing for 200 procedures by provider. Aetna said it currently offers cost estimates for around 490 doctor services, with specific out-of-pocket charges for the in-network providers. The data are a key competitive issue for the transparency-tool companies. " This barrier is a very real one, " said Bobbi Coluni, senior director of consumer solutions at Thomson Reuters. " There have been cases where we've worked through it, and cases where we haven't been able to. " Castlight said it has gotten data from some insurers and not others. The company, along with some employers that are potential clients, has been trying to prod health plans including WellPoint and UnitedHealth to provide information. UnitedHealth said it supports " making health-care information more transparent and will work with vendors who agree to uphold the same standards of data collection and usage that we adhere to. " In June, Mr. Darrow of Indiana was one of seven employer representatives, along with Castlight officials, who met with WellPoint at a hotel in Indianapolis. A WellPoint handout from the meeting pointed to agreements with providers that " prohibit disclosure of terms and rates " and are " very restrictive, " among other factors. *Write to * Wilde Mathews at anna.mathews@...<https://mail.google.com/mail/?view=cm & fs=1 & tf=1 & to=anna.mat\ hewswsj> via online.wsj.com<http://online.wsj.com/article/SB100014240529702039118045766532828\ 23208852.html> This is Precious: CA Assemblywoman Hayashi charged with shoplifting at Neiman Marcus | Matier And Ross | an SFGate.com blog<http://ptmanagerblog.com/this-is-precious-ca-assemblywoman-mary-hayash> Posted about 15 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=77647455> Assemblywoman Hayashi charged with shoplifting at Neiman Marcus Share 94 <http://blog.sfgate.com/matierandross/files/2011/10/hayashi-mary.jpg> <http://blog.sfgate.com/matierandross/files/2011/10/hayashi-mary.jpg> Assemblywoman Hayashi in 2009 Democratic Assemblywoman Hayashi of Castro Valley has been charged with felony grand theft after being caught on video surveillance allegedly shoplifting more than $2,000 worth of merchandise from San Francisco’s Neiman Marcus store on Union Square, prosecutors say. Hayashi, 45, who has served in the Assembly since 2006 — and is married to Alameda Superior Court Judge Dennis Hayashi — was arraigned Thursday in San Francisco Superior Court. She had earlier posted $15,000 bail. Hayashi was stopped by Neiman Marcus’ security detail shortly after leaving the store around 12:15 p.m. Tuesday with a shopping bag that included three items worth $2,450 that she hadn’t paid for when she checked out at the register, the district attorney’s office said. Prosecutors did not specify what the items were, but a source familiar with the case tells us they were leather pants, a black skirt and white blouse. Hayashi was questioned by police at the Tenderloin Station and eventually booked at the County Jail on one count of felony theft. She pleaded not guilty Thursday before Judge Feng and is due back in court Nov. 15 to set a preliminary hearing. District attorney’s spokesman Omid Talai said a grand theft conviction carries a maximum sentence of three years in prison, although it’s unlikely Hayashi would face the stiffest penalty because, according to authorities, this was her first arrest. Hayashi spokesman Sam Singer called the assemblywoman’s arrest a mistake, saying she had walked out of the store with the items unintentionally and intended to go back. Hayashi is “distraught by this misunderstanding,” Singer said, “and she believes this will be clear up in the near future.’’ He added, “She apologizes for any misunderstandings.’’ Just two years ago, Hayashi pumped at least $202,212 of her own campaign money into helping elect her lawyer husband to the Alameda County bench. Hayashi was born in South Korea and was the first Korean American woman to be elected to the state Legislature, according to her legislative biography. She chairs the Assembly Committee on Business, Professions and Consumer Protections. Before winning election from the 18th Assembly District, which includes Hayward, San Leandro, Castro Valley and Dublin, Hayashi was a public health analyst and member of the state Board of Registered Nursing. Posted By: Matier and Ross<http://blog.sfgate.com/matierandross/author/matierandross/>( Email<http://blog.sfgate.com/matierandross/2011/10/28/assemblywoman-mary-hayashi\ -charged-with-shoplifting-at-neiman-marcus#>) | Oct 28 at 12:21 pm Listed Under: Matier and Ross Column<http://blog.sfgate.com/matierandross/category/matier-and-ross-column/>, Uncategorized <http://blog.sfgate.com/matierandross/category/uncategorized/>| Permalink<http://blog.sfgate.com/matierandross/2011/10/28/assemblywoman-mary-hay\ ashi-charged-with-shoplifting-at-neiman-marcus/>| Comments & Replies (0)Comments & Replies (1)Comments & Replies (126)<http://blog.sfgate.com/matierandross/2011/10/28/assemblywoman-mary-hayashi\ -charged-with-shoplifting-at-neiman-marcus#comments>: Post CommentPost CommentPost Comment<http://blog.sfgate.com/matierandross/2011/10/28/assemblywoman-mary-hayas\ hi-charged-with-shoplifting-at-neiman-marcus#comments> [image: Bookmark and Share] <http://blog.sfgate.com/matierandross/2011/10/28/assemblywoman-mary-hayashi-char\ ged-with-shoplifting-at-neiman-marcus#> | Email<http://blog.sfgate.com/matierandross/2011/10/28/assemblywoman-mary-hayashi\ -charged-with-shoplifting-at-neiman-marcus/mailto:?subject=SFGate:%20Assemblywom\ an%20%20Hayashi%20charged%20with%20shoplifting%20at%20Neiman%20Marcus%26body\ %3DHere%20is%20a%20blog%20post%20I%20found%20on%20SFGate%20that%20I%20thought%20\ you%20would%20be%20interested%20in.%0A%0Ahttp://blog.sfgate.com/matierandross/20\ 11/10/28/assemblywoman-mary-hayashi-charged-with-shoplifting-at-neiman-marcus/> via blog.sfgate.com<http://blog.sfgate.com/matierandross/2011/10/28/assemblywoman-ma\ ry-hayashi-charged-with-shoplifting-at-neiman-marcus/> You just can't make this stuff Up!!!! 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