Will Smith, the co-director of Grand Teton National Park, demonstrates some daring-do to rescue people from mishaps in the mountains of Wyoming. But just like medical directors for health systems, insurance companies, and pharmacy benefits management firms, Smith is in the business of setting policies and protocols.
The company has more than 15,000 employees—or about a third of the eligible employees in those four locations—enrolled in direct contracts. Boeing has dubbed the direct contracts its Preferred Partnership health plan. Should insurers worry that other large companies will cut them out?
PBMs say their deals need to be kept private so they can drive a hard bargain with manufacturers. But employers, consumer groups, and legislators are calling for more PBM transparency. There’s bipartisan support for legislation that would force more openness.
The insurer’s general manager of behavioral and EAP services wants to make mental health care more mainstream. Only 17% of American adults function with optimal mental health. “We talk about it as if it’s them over there, but 83% of us have a need.”
Studies comparing team care of diabetes with traditional care should be redesigned, say researchers. “In order for redesign studies to support generalization of their findings, methodology should include a randomized, controlled study design with intention-to-treat analysis,” the study states.
State tort reforms have all but relegated the malpractice crisis to the history books. But there’s good news for those of you into all things retro: The House of Representatives just voted to fix the malpractice crisis by a 222–197 margin.
Seven biosimilars have crossed the FDA-approval finish line. The FDA has largely held to the abbreviated pathway it laid out originally. The big change is that the rest of the world is starting to understand it. Approvals are based upon “the totality of evidence,” “analytic similarity,” and clinical performance with much less emphasis placed on phase 3 trials.
The medical home model for delivering health care is getting tested for people with mental health problems. Missouri has been a pacesetter. By using a cost-based prospective payment system for health home patients, Missouri Medicaid shifted providers’ emphasis from periodic acute care-to-care management with a focus on preventing high-cost exacerbations.
Medical directors have been around for a long time. Today, to reflect expanding duties, there’s a bewildering array of other titles too. Are we all agreed on what titles mean, then? No way. For example: Many executives who are called CMOs—or something else—are also taking on the new duties of value-based care.
Opioid overdoses have killed more than 300,000 since 2000—and the death rate is rising. Buprenorphine could save thousands more lives than it does—if it weren’t for legal barriers, a fear of disruptive patients, and insurance red tape. And it can be prescribed in the primary care physician’s office.
David Hanekom, MD, and Steven Udvarhelyi, MD, are two former medical directors who became CEOs. Their new job means really understanding the business side of health care, the need for healthy members, and a healthy bottom line. But it also means watching costs and keeping stakeholders —which can include stock holders—happy.
The disease is endemic in Latin America, where an estimated 8 million people are affected. It is a lifelong illness and, if untreated, it can result in life-threatening health conditions. Enter benznidazole, which shows we can respond to these new threats in both a medically and an economically responsible manner.
Demand for mental health services outstrips the supply of psychiatrists. Aggravating the situation: Many psychiatrists don’t take insurance. Nurse practitioners and physician assistants are beginning to fill the gap, but some professionals look askew at this team-based approach, wondering if care is being compromised.