Health Maintenance Organizations

As a young man, Chant Yedalian played a role few mothers would wish for their sons. He helped his cancer-stricken mom pick out a wig, one so convincing that few knew her hair had fallen out from chemotherapy. Every two weeks, he took it to be cleaned. On her lunch hour, he walked her several blocks from her job as director of a church preschool to her breast cancer treatments at Kaiser Permanente's center in Los Angeles.

Molina Healthcare Inc. said Monday that it had agreed to buy a New Mexico managed-care company for $69 million as part of an effort to expand its Medicaid market. The Long Beach health maintenance organization, which specializes in serving the poor and people on Medicaid, said the acquisition of Health Care Horizons of Albuquerque should begin boosting earnings as soon as it closes in the third quarter of this year.

The Supreme Court took up this year's major healthcare case Tuesday in a dispute that pits the compassionate conservatism of Texas Gov. George W. Bush versus the pro-business stand of the Bush administration. At issue is whether patients who are denied needed medical care can sue insurance companies and health maintenance organizations. In 1997, then-Gov.

In the long negotiations that led to the workers' compensation reform package, one of the most contentious issues was who should pick the doctors treating injured workers. In the end, the governor and lawmakers settled on a uniquely California approach: creating HMO-like networks of doctors. California was a pioneer in the formation of health maintenance organizations, and if the reform bill is approved today as expected, the state will launch a new cottage industry in managed care.

The 1.4 million California seniors who belong to Medicare HMOs are getting more bang for their buck this year, reversing a two-year period during which benefits had eroded, according to a new study released today. "We're finally seeing some good news," says Dr. Mark Smith, president of the California Healthcare Foundation, an Oakland-based philanthropic group that along with Consumers Union produces the annual survey. "The past two years haven't been easy for seniors."

Ian Malone, a brain-damaged boy who caught Al Gore's attention during the 2000 presidential campaign because an HMO threatened to cut his coverage, has died at age 4 1/2. Ian died in his sleep Saturday, his parents said. "Ian's short life was a constant battle to improve the system for those who will come after him," Dylan and Christine Malone said. "We will sorely miss his beautiful smile and ready laugh, and are sorry his journey had to end so soon."

The California Public Employees' Retirement System voted Wednesday to oust 38 hospitals from its Blue Shield HMO network because they were deemed too pricey -- a step expected to influence healthcare purchasing decisions nationwide. Directors of CalPERS, the nation's third-largest buyer of employee health benefits, said they had taken the action to keep a lid on premium hikes. The pension fund, which provides medical benefits for 1.

Rate increases at health maintenance organizations are expected to be lower for the second year in a row as the insurance business becomes more competitive and employers continue to shift more costs to workers, a new study indicates. The 2005 increases are still expected to be steep, however, and are unlikely to sink to the single digits, said Hewitt Associates, which conducted the study. As companies begin to negotiate HMO rates for 2005, the average increase offered by insurers is 13.7%.

The Supreme Court's ruling Monday that severely limits some consumers' ability to sue their health insurers was hailed by the industry as a big step toward holding down healthcare costs and decried by consumer advocates as an impingement on patients' rights. Here are answers to questions consumers might have about the decision. Question: What does the ruling mean? Answer: It means that many HMO members cannot sue their health plans in state courts for denying treatment.

Patients who are harmed because their managed healthcare plan refused to pay for medical treatment cannot sue the insurer, the U.S. Supreme Court ruled Monday, closing the courthouse door to more than 130 million Americans who rely on coverage provided by a private employer or a labor union. The 9-0 ruling shields most health maintenance organizations from being sued and possibly forced to pay huge verdicts for their mistakes.