They are: do more for less, deploy narrow provider networks, master new benefit designs, integrate data — and cooperate, learn to align with providers, consider clinicians’ morale, embrace personalized medicine, create a culture of coverage, and keep learning. Health plans that do these will not only cope, they’ll thrive.
Defining mental illness raises a slew of profound political, economic, personal — and, most recently, scientific — issues. A single text that claims to offer all the answers to all the complex questions is bound to be a lightning rod. Such is the fate of the Diagnostic and Statistical Manual.
The special investigations units at health plans too often played the pay-and-chase game with physicians who became crooks. Not anymore. Technology and employees with specialized skills — such as auditors and even medical directors — are now in place to tag false claims, and then talk to the doctors.
Sure, nine dropped out of the elite program but the survivors seem to be making headway. CMS figures the Pioneer program saved about $33 million in 2012. Not much, when compared to overall Medicare spending but, some argue, enough to hope for even more progress.
Businesses just don’t have a realistic view of the potential and the costs of new cutting-edge medications. They need to bone up. If they do not, their workers will pay the price by not having access to products that can improve their health.
There are certain things health insurers can do to better their chances for cost-efficiency and improved care. For instance, make sure your physicians have the expertise to manage the types of cancer seen today. Keep an eye on pharmacogenomics testing for breast and colon cancer.
Insurers looking for some financial relief hope that the people who run the FDA’s review process take note
The tools are imperfect. Even so, physicians and patients are not taking advantage of practices that save lives.
Providers are not the only ones who need to encourage employees to get more involved with their care, a study argues
This method of matching drugs to patient starts with RA but may eventually be used for many other conditions