Health Insurance

If employers have their say, your patients soon may become more interested in their health, turning to you for everything from stress management to healthy eating habits.

More than 83% of the nation's employers currently use health risk assessments to make employees aware of health risks as a way to encourage more prevention. A study released in July by Forrester Research Inc. showed signs that the assessments might have an effect on patient behavior, but the study's author says there's still a way to go before they have a measurable impact on health care costs.

The study, "What Consumers Do With Health Risk Assessments," found that 17% of employees who take the HRAs usually discuss the results with a physician and that 8% enroll in some type of structured wellness program designed to address a specific risk. The survey of 5,036 commercially insured people was conducted in October 2007.

Some experts say those percentages are good, given that more than two-thirds of the population is generally healthy. But study author Elizabeth Boehm, principal analyst in the Customer Experience for Healthcare & Life Sciences division of Forrester, said it could be better because "just about everyone has some behavior they could improve."

"The biggest issue is certainly the catastrophic health care costs, especially if you are large and self-insured," Boehm said. "But [employers] are also looking at issues such as productivity and absenteeism, and those are [affected] by fairly minor healthy behaviors like getting enough sleep or eating better."

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Former UnitedHealth Group Chair and CEO William McGuire, MD, has agreed to forfeit another portion of the fortune he amassed during the 17 years he led the company, settling with investors in a lawsuit over alleged stock-option backdating.

Under the agreement, Dr. McGuire will pay $30 million to United investors in a class-action lawsuit led by a California pension fund and will surrender options to purchase 3.65 million shares of stock granted between 2003 and 2005. At mid-September's stock prices, those shares would be worth about $100 million. The case had been set for trial in September.

"In effect, this was an example of runaway executive compensation," said Peter Mixon, general counsel for the California Public Employees' Retirement System (CalPERS).

The CalPERS agreement is the third settlement involving the former CEO regarding alleged improper stock option backdating.

Backdating, the practice of retroactively assigning the grant date to a day the stock was at a low value, allows for automatic profit when options are sold at a higher price. It is not illegal, but investors are supposed to be informed when a company backdates stock options.

United already had agreed to pay $895 million to the same plaintiffs and is awaiting final approval of that deal by a federal judge. Former United General Counsel David Lubben also settled, paying $500,000 to plaintiffs.

Dr. McGuire did not admit wrongdoing; nor has he done so in any previous settlement. In a December 2007 settlement with the Securities and Exchange Commission, Dr. McGuire agreed to pay the SEC a $7 million fine, return $11 million in what the SEC called "ill-gotten gains," plus $1.7 million in interest, while also returning stock options and cash to United.

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A pair of studies looking into the proposed merger of Highmark Inc. and Independence Blue Cross gave no clear answer to the question of whether the state's insurance deparment should approve the deal.

A report from LECG Inc., an Emeryville, Calif.-based company that offers expert testimony and analysis, said whether state law dictates that consolidation not be approved depends on how market share is defined. Another, by New York-based international financial consulting firm The Blackstone Group, was not conclusive as to whether the deal would fail to benefit policyholders and hurt network access. Blackstone said it had found no evidence that it would but noted that further data could change that conclusion.

The reports reflect the various definitions that regulators, experts, physicians and the plans themselves have offered in debating whether a Highmark-Independence merger should be approved. The Pennsylvania Dept. of Insurance commissioned the reports, released in early September, to help determine if it should approve the deal.

"In terms of the definition of what a market share is, the answer is going to be a combination of fact and interpretation of law," said Melissa Fox, a spokeswoman for state Insurance Commissioner Joel Ario. "Everything on the table will be considered."

The LECG report said that, assuming the two compete in a statewide market and using premiums as a measure of market control, the consolidated firm would have too large a market share as defined by the state statute that applies to mergers.

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Ever since the New Jersey Supreme Court liberalized and modernized the use of learned treatises, the use of medical literature to support one’s theories or to cross-examine an adversary’s experts has proven helpful. [N.J.R.E. 803(c)(18); Jacober v. Saint Peter’s Medical Center, 128 N.J. 475 (1992).]

While this liberalization was a welcomed change to the stifling old rule, which in reality prevented the use of learned treatises, new issues regarding the validity of medical research mandates that the trial attorney now research not only one’s opponent’s experts, but investigate the authors of those learned treatises which will be relied upon by one’s adversary.

Prior to 1992, one could only utilize a learned treatise during cross-examination, if and only if, the defense expert acknowledged that the learned treatise was authoritative. Should the expert fail or refuse to acknowledge such authoritativeness, the attorney was precluded from using the learned treatise to cross-examine that expert. In 1992, the New Jersey Supreme Court in Jacober, adopted the Federal Rule of Evidence regarding the introduction and use of learned treatises. Shortly thereafter, the “Jacober rule” was codified and became a part of New Jersey’s Rules of Evidence, 803 (c) (18).

This is an excerpt from the article, Beware of the Literature Reprinted: Investigation of adversary's treatises is now required, from the September 22, 2008 edition of the New Jersey Law Journal. You can read the full article here (PDF).

With the recent and overwhelming reports of the severe brain trauma suffered, and more often ignored, by members of the National Football League, researchers at Boston University's School of Medicine have a new plan to study the long-term effects of concussion trauma on a player's brain. A dozen athletes, including six N.F.L. players and a former United States women’s soccer player, have agreed to donate their brains after their deaths to the Center for the Study of Traumatic Encephalopathy.

The new Boston University center is being financed primarily by the university and a $100,000 grant from the National Institutes of Health, said Dr. Robert A. Stern, the program co-director along with McKee. It will operate in collaboration with the Sports Legacy Institute, a nonprofit organization founded last year by Chris Nowinski, the former Harvard University football player and professional wrestler, and Dr. Robert Cantu, a co-director of the Neurological Sports Injury Center at Brigham & Women’s Hospital in Boston.

You can read more on this story in a New York Times article here.