Mid-Atlantic | Summer | 2008 | Health Plan Analysis

Maryland regulators cited and fined Coventry Health Care after finding the carrier failed to comply with state laws regarding prompt payment of claims, appeals, greivances, and more. Meanwhile, AMERIGROUP has walked away from its Medicaid contract with the District of Columbia, even though the District has dropped its lawsuit against the company.

The Virginia Business Coalition on Health is starting its own version of a pharmacist-led diabetes management program in Chesapeake. Mid-Atlantic health plans, meanwhile, are using various approaches to tame specialty drug costs. Maryland has begun a small business insurance subsidy program, with four insurers offering plans for the program. Medicare Advantage law changes look like they'll favor XLHealth, which offers special needs plans in six states under the Care Improvement Plus name. Meanwhile, CareFirst is seeking to offer Mid-Atlantic physicians extra payment in return for setting up "medical homes" for CareFirst members. Kaiser is preparing to offer self-insured plans as part of its effort to move beyond the HMO model it made famous.