Managed Care

 

Briefly Noted

MANAGED CARE July 2013. © MediMedia USA
News & Commentary

Briefly Noted

In what’s being called one of the first instances of a group using the Affordable Care Act to contest an insurer’s benefit package, a women’s advocacy group says that a beneficiary should not have to pay for a dependent’s pregnancy costs. The Wall Street Journal on June 4 reports, “The complaints are rooted in a health law provision requiring employers to allow workers to keep dependents up to 26 years old” on coverage plans.... The Supreme Court ruled last year that states could opt out of Medicaid expansion, and so far 14 have done so, according to a report in the June issue of Health Affairs. This saves the government about $8.4 billion a year, but ensures that 3.6 million more people will be without insurance. The states not participating, though, are likely to see an increase in spending in the short run because they’ll have to spend more on uncompensated care.... CareFirst BlueCross BlueShield’s foray into the world of patient-centered medical homes has paid off handsomely. The health plan, with 3.4 million covered lives in Maryland, Washington, D.C., and northern Virginia, reports that it saved $98 million last year with its patient-centered medical home. It saved $38 million in 2011. Some experts worry that medical home savings will dwindle over time as doctors run out of obviously wasteful methods to eliminate. Most of CareFirst’s savings came from lower drug spending, less use of emergency departments, and fewer hospital admissions.... COPD hits women hardest, a report by the American Lung Association reaffirms. Women are 37% more likely to have COPD then men. About 7 million women are known to suffer from the disease, and millions more have it but have not been diagnosed.... We spend $200 billion each year, mostly in unneeded hospitalizations and doctor visits, thanks to the improper use of prescription drugs, according to a study by IMS Health’s Institute for Healthcare Informatics. The study, released June 19, says too many patients take the incorrect drug or dose. There is often inadequate oversight when patients are taking more than one medication. The study also cites the misuse of antibiotics. The authors say that financial incentives included in the ACA for better care coordination may help reduce the amount of waste.... Men are much more likely to develop health care related infections than are women, according to a study in the Journal of General Internal Medicine. Men have a 60% higher risk of developing bloodstream and surgical site infections.

Meetings

2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014
6th Semi-Annual Diagnostic Coverage and Reimbursement Conference Boston December 4–5, 2014
Customer Analytics & Engagement in Health Insurance Chicago December 4–5, 2014
Pharmaceutical and Biotech Clinical Quality Assurance Conference Alexandria, VA December 4–5, 2014
9th Semi-Annual Medical Device Coverage and Reimbursement Conference San Diego December 5, 2014
8th Annual Medical Device Clinical Trials Conference Chicago December 8–9, 2014
HealthIMPACT Southeast Tampa, FL January 23, 2015