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In a marketplace fraught with downsizing and restructuring, many top administrators find themselves having to change careers.   Vignettes: Abbie Leibowitz, MD Kevin Roache, MD John C. Beeson, MD, MBA When Anthem purchased HMO of Colorado and HMO of Nevada as part of a larger deal, George Kandel, MD — the plan’s longtime CEO and … Read more

When uninsured immigrants fail to pay their bills, the University Medical Center in Tucson, Ariz., might just report them to the Department of Homeland Security. Michael S. Victoroff, MD The folks at University Medical Center in Tucson, Ariz., have come up with an interesting strategy to reduce financial losses from uncompensated care. Their idea is … Read more

Merck will drop the Purchase Price of its Hepatitis C Medication Zepatier by 60%, The business announced yesterday. Additionally, it intends to cut the purchase price of”various other” medication by 10 percent. In doing this, Merck went farther than just two competitors–Pfizer and Novartis–that said they wouldn’t increase drug prices for the others of 2018. … Read more

One of the most promising changes created in the new Stark regulations, published by HCFA last year, is the proposed “fair market value” exception to the Stark law’s general prohibition of referrals of certain health services between physicians and other providers with whom they have financial relationships. The proposed exception would allow financial arrangements that … Read more

Insurers want to obey laws, but those laws are hard to understand and it is tempting to simply define coverage equality downward New rules governing treatment of patients with mental health and substance abuse disorders raise more questions than they answer. In November, three federal departments, including Health and Human Services, issued rules under the … Read more

Preceding Highmark Wellbeing, Dr. Winkenwerder filled in as Director of The Winkenwerder Organization, gaining practical experience in essential warning administrations to inventive medical care associations. The company’s customers included enormous, unmistakable US medical services associations like Kaiser Permanente and Johns Hopkins Medication, and driving innovation organizations acquainting new IT arrangements with the medical services area, … Read more

Employers in revolt against fast-rising premiums could ask HMOs to pay more attention to time-loss management. NCQA’s interest may encourage this approach. Senior Editor Looking for a connection between what HMOs do and controlling indirect costs of ill health, such as absenteeism, has never been so heated a subject for discussion as, say, defined contribution. … Read more

Comparison of Amlodipine/Valsartan Fixed-Dose Combination Therapy and Conventional Therapy The use of a single-pill combination of amlodipine/valsartan resulted in higher acquisition costs but fewer clinic visits, laboratory tests, and electrocardiograms — and therefore lower gross costs — compared with the use of individual drug components Teaching Residents Established Guidelines And Standards of Care To Strengthen … Read more

In general, salaries within managed care organizations are increasing to keep pace with market demands. Warren Surveys’ Spring 2000 Salary Survey concludes that the rise in salaries indicates that health plans are “keeping compensation at market levels, and understand that in a tight labor market a highly trained employee with managed care experience is a … Read more

Employers Mostly in the Dark When It Comes to Biologics A national survey finds big gaps in knowledge about how to manage these costly drugs A national survey finds big gaps in knowledge about how to manage these costly drugs Principal, Institute for Integrated Healthcare A new survey finds that 1 in 4 employers has … Read more

Hundreds of products are at some stage of development, but only a handful may get on the market in the next few years The biosimilar segment of the pharmaceutical industry is on fire. Some 700 biosimilars are at some stage of development, according to Biosimilarpipeline, and the website reports that more than 660 companies are … Read more

Thus, opioid pain relievers are all drugs which are utilised to manage pain. Plus so they should be utilized if other medicines and treatments are unable to offer enough treatment, or else they can not be utilized as a result of safety concerns. And certain opioid drugs can also be utilized to deal with opioid … Read more

Divided into many different pressure groups, physicians mostly can live with the ACA. But now they have MACRA, MIPS, APM, and other puzzles to figure out. As the 1972 movie The Candidate closes, the upstart Bill McKay, played by a young Robert Redford, has just won a surprise victory for a Senate seat. He pulls his campaign … Read more

Along side Ocean Farm inch, a steel-netted pencil how big a town block. Adding a thick vacuum hose into the pencil, the boat’s crew started to pump brawny mature salmon out from their water and right into a tank below deck. Later, they off loaded the fish in a shore-based processing center possessed by SalMar, … Read more

MD, MPH, guided the country’s largest not-for-profit health plan through the tumultuous managed care decade.When MD, MPH, departing CEO of Kaiser Permanente, says that his immediate plan upon retirement is to write a book, one wonders whether he is following the example of Winston Churchill, who said “History will be kind to me for I … Read more

Parent Directory 28-Aug-2000 11:10 – ../../../../archiveMC/9711/QNA.1.GIF 17-May-2000 12:21 1k 9711.compmon.shtml 17-May-2000 12:19 1k 9711.outlook.shtml 17-May-2000 12:20 1k 9711.editorsmemo.shtml 17-May-2000 12:19 2k 9711.contents.shtml 17-May-2000 12:19 4k 9711.news.shtml 17-May-2000 12:20 7k 9711.legal.shtml 17-May-2000 12:20 7k 9711.washington.shtml 17-May-2000 12:21 8k 9711.employer.shtml 17-May-2000 12:19 8k 9711.ethics.shtml 17-May-2000 12:20 8k 9711.states.shtml 17-May-2000 12:21 8k ../../../../archiveMC/9711/9711.compmon.ext.gif 17-May-2000 12:19 8k 9711.capitation_part..> 17-May-2000 … Read more

Employers are adopting disease management programs in a big way to slow the pace of health care premium increases, according to a survey of 3,000 businesses. This is just one of the elements of an unexpectedly positive report by Mercer Human Resources that shows that health care premiums in 2003 did not grow so much … Read more

When it comes to controlling rising health care costs, consumers think the responsibility rests squarely on health insurance companies’ shoulders. About 94 percent of consumers surveyed by Great-West Healthcare, a national provider of employee benefits, say that insurers are “extremely” (62 percent) or “somewhat” (32 percent) responsible for controlling costs. In contrast, one in five … Read more

A Deloitte & Touche study has added fuel to an argument the health insurance industry has advanced of late: When stacked against other issues, health care barely rates a yawn. The survey, conducted in conjunction with the International Society of Certified Employee Benefit Specialists, suggests that retirement planning is a far more pressing issue than … Read more

Most acute-care hospitals that participate in Medicare will receive a 0.5-percent increase in their base payment rate in fiscal 1999, though some 360 acute-care hospitals will see a 0.8-percent increase. Most of the latter group are hospitals that lost money on Medicare patients during the last three years, and as per the Balanced Budget Act, … Read more

Committee’s future accounts about the outcome of uninsurance. The Committee reviews and outlines the literature concerning exactly what socio economic, demographic, and geographic traits clarify the prosecution both jointly and as members of all classes from the overall populace which can be much more inclined than average to become non refundable. The big amount and … Read more

The Centers for Disease Control and Prevention on Thursday cautioned that contaminated medical instruments applied in open-heart operations might possibly be to blame for a rash of diseases from patients at the USA and Europe. Data printed From the CDC’s Morbidity and Mortality Weekly Report imply at least 11 patients at the US were infected … Read more

Two vaunted ideals of health care, experts say, should be perfectly aligned. And they almost are. Timothy Kelley Senior Contributing Editor Health care doesn’t lack for big ideas, even if their definitional boundaries do sometimes get fuzzy. Take “population-based medicine” and “patient-centered health care,” for example. Both are phrases we hear and read every day, … Read more

Most U.S. residents that talk This report explains what’s now called language barriers in medical maintenance and summarizes a research agenda based on mismatches between the present state of comprehension of language barriers and also what healthcare analysts will need to understand. Three wide areas requiring more research have been shared: the ways language challenges … Read more

The new system is supposed to have transparent pricing, but some say it is susceptible to manipulation, which was AWP’s downfall John Carroll A little more than a year ago, 45 states based their Medicaid drug payments on a common benchmark: an estimated acquisition cost based on the average wholesale price (AWP) of the therapeutic. … Read more

Your decision implies that approximately 2,400 additional kids inside the U.S. are entitled to get the medication, bringing the entire quantity of the qualified to receive its procedure while in the U.S. to almost 11,000. The FDA accepted lumacaftor/ivacaftor Last year for those who have CF ages 12 and older individuals who have just two … Read more

As Mentally Ill Fall Through Net, Insurers Asked to Take Up Slack Innovative government projects might point the way toward how plans can save money while addressing a growing public policy concern Andrew Sperling, JD, director of federal legislative advocacy for the National Alliance on Mental Illness, insists that our society knows what mental health … Read more

Faced with continually rising health care costs, employers are looking to consumer-directed health plans (CDHPs) and wellness programs to keep them down. There was a 43 percent increase in the number of CDHPs offered this year, compared to 2007. These plans make up nearly 13 percent of all plan offerings by employers. The percentage of … Read more

COVER STORY PSOs: What Happened? They were expected to spur the growth of managed Medicare. So where’s the stampede? Does the lack of applications demonstrate that HCFA is out of touch with the realities of managed care? The Mountain Named JCAHO Meets the Tremor Called ISO Meet ISO 9000, standards created in Europe to ensure … Read more

WellPoint and Cigna are turning heads in the financial world. Cigna’s second-quarter earnings rose 73 percent from the same period last year to $720 million as its earnings kept well ahead of medical costs thanks to higher premiums and lower operating costs, reports the Wall Street Journal. Meanwhile, the newspaper says that WellPoint’s earnings are … Read more

Plans have to be developed to boost antibiotic-prescribing. Our objective is to examine of educational programs targeted toward improving antibiotic-prescribing by doctors or antibiotic-dispensing from pharmacists, in both Primarycare and hospital settings. We found 78 studies for investigation, 4-7 at Primarycare and 3 1 in hospital settings. The studies differed widely InDesign but mostly reported … Read more

John Marcille We tiptoe into the waters when fishing for a metaphor. That’s especially true when the fish sought is called complementary and alternative medicine. Like the barkeep Rick in Casablanca, we will remain “carefully neutral” by not naming specific therapies. We will only say this: Sometimes we want so much for things to be … Read more

By Mark D. Abruzzo, J.D. The Illinois Supreme Court last fall followed a national trend of courts holding managed care organizations liable for medical malpractice under a variety of traditional legal theories. That court, in Petrovich v. Share Health Plan, ruled that HMOs can be liable vicariously for acts of their contracted physicians under theories … Read more

The Evolving Health Plan The consumer-directed model isn’t taking the country by storm, but its innovations are influencing other coverage designs MargaretAnn Cross New Imaging Controls Strict, But May Be Easier on Doctors Preauthorization procedures for costly new imaging technologies aim to help doctors learn the rules to avoid denials Tom Reinke Plans Unsettled By … Read more

Evidence-based medicine can help cut costs and raise the standard of care, but we’ll need a common measure of quality Ricardo Guggenheim, MD In an ideal world, if you were a 57-year-old man suffering from a myocardial infarction, it wouldn’t matter whether you lived in Miami or Missoula, because your chances of survival would be … Read more

The Colorado Division of Insurance imposed its largest-ever fine, $126,000, on Cigna Health Care and Connecticut General Life Insurance, a Cigna indemnity unit, for violating state law by failing to actively market a low-cost standard health plan to small businesses. The state also cited the company for inadequately responding to complaints, issuing incorrect policy forms, … Read more

We often use such words as “quality,” “transparency,” “accountability,” “evidence-based,” and “effectiveness,” but not always in the same ways. Quality, like beauty, is in the eye of the beholder. The word is ubiquitous in health care, but what does it mean to health plan leaders, providers, patients, and payers? Is quality a process, a tactic, … Read more

STATE INITIATIVES When It Comes to Viagra, State Medicaid Programs Vary State Medicaid programs are weighing their options now that the Clinton administration has said they must cover medically approved uses of Viagra, Pfizer’s anti-impotence medication. States retain the option oflimiting the number of doses of the drug they’ll pay for, and last month New … Read more

There’s a lot about technology in this issue. A story examines how health plans are dealing with the genomics revolution. Read about some amazing patient-monitoring systems that promise a bright future for disease management. Then get a glimpse at how information technology might at last foster greater cooperation between health plans and provider networks. I say “might” because … Read more

“Value-based Insurance Policy Plan” Intends to increase Healthcare quality And reduce costs by applying financial incentives to market efficient healthcare solutions and consumer choices. Health benefit plans are built to lessen barriers to improving and maintaining health. By masking preventative care, health visits and treatments such as medications to manage blood pressure or diabetes in … Read more

Humana is phasing in a four-tier formulary that categorizes prescription drugs by costs, rather than generic or brand status. The higher the drug’s acquisition cost — regardless of whether it’s a branded or generic product — the higher the tier it lands in. The MCO says the structure gives it more flexibility to manage pharmacy … Read more

Humana and United HealthCare will never make it to the altar. The two companies terminated their merger agreement after a stock swoon dropped the value of the union from $5.3 billion to $3.1 billion.Wall Street got nervous when United announced a $565 million second-quarter loss stemming from a one-time $900 million charge associated with “strategic … Read more

Managed care has been called a lot of things. Uncaring. Unethical. Unfriendly. Unfair. And a few more “un” words that cannot be printed here. Why the “uns”? Enrollees lose choice of doctors and hospitals. The doctor-patient-payer relationship seems more important than the doctor-patient relationship. Doctors are pressured to see more patients in less time and … Read more

Physician practice managers are in a central position because they interact with health plans that determine quality targets and financial incentives, such as pay-for-performance programs, and with the physicians and other providers in their organizations. A study published in Medical Care Research and Review bears this out. Researchers interviewed practice managers about how financial incentives … Read more

Anthem’s vice president of provider alignment solutions wants providers to know that the spigot of upside-only risk arrangements will not stay open forever. Providers who take on downside risk are more likely to put “the pedal to the metal,” acknowledges Mai Pham, MD, Anthem’s new vice president of provider alignment solutions. The country’s second-largest health … Read more

Jean Lawrence Washington Initiatives The voters have spoken: “Fix Medicare without shortchanging Grandma (or gutting the system before we can benefit) and do something about the uninsured.” But by returning a Democratic president to joust with a Republican Congress, the voters have made it likely that such beloved perennials as Medicare and health care reform … Read more

A brand new drug made by Merck & Co and also Pfizer Inc obtained U.S. endorsement on Wednesday to take care of type II diabetes, and the Food and Drug Administration said, adding still another competitor to some developing group of treatments. The oral medication, known as as ertugliflozin, will probably likely be sold under … Read more

You get what you pay for. ” Too often, that’s a justification for high prices. Yes, the Jaguar is a nice car, but with the quality-control problems that it had until recently, were you really getting what you paid for? Employers are growing increasingly savvy about what they get for their money, and so are … Read more

Some insurers are changing their rules after the AMA and others said prior authorization could result in treatment delays that can be deadly. Prior authorization is one of the major tools in the insurer toolkit for managing cost and utilization. Most providers hate it, none like it. But prior approval for medical treatment for those … Read more

Advocate says: Physicians, Hospitals To Lose Clout And Numbers Charles B. Inlander has been president of the People’s Medical Society since the group’s founding in 1983. The idea for the organization came from Robert Rodale, second-generation head of the health and horticulture publishing company. The mission of the society is “to get information to the … Read more

Despite all the recent discussion about Social Security reform, chief financial officers in the United States say that rising health care cost remains their top concern, according to a survey by Duke University and CFO Magazine. Data come from a survey of 293 CFOs in the U.S. who expect health care costs to increase by … Read more

The crisis some employers feared that the Mental Health Parity Act would bring about hasn’t happened. But neither has an avalanche of care. David L. Coleman Substance … or symbolism? In the year since the federal Mental Health Parity Act took effect, has there been any effect on patient care or on those who pay … Read more

If a doc is compensated when he schedules a patient visit to convey the routine results of a lipid test, but not when he phones the patient, which behavior will he choose? Michael S. Victoroff, MD MANAGED CARE April 2003. ©MediMedia USA If a doc is compensated when he schedules a patient visit to convey the routine … Read more

Untangling the HIE Mess Technical, financial, existential—health information exchanges (HIEs) have been plagued by all sorts of problems. But payers want in because of value-based payment. A High-Stakes Match Game To Keep Patient Identities Straight Jan Greene Departments MEDICATION MANAGEMENT Life in the Fast Track Two companies, two drugs for Duchenne muscular dystrophy in the … Read more

Many young adults are choosing not to purchase health insurance, according to the Census Bureau. Some 16 million people between 18 and 34 find the costs prohibitive. Choice is not the only issue; many work in businesses that do not offer insurance. Those who have lost their jobs find COBRA too expensive as well…. Baby … Read more

While policy makers haggle over President Bush’s budget request for the system, an ominous question looms: Can money solve all the problems? Frank Diamond Senior Editor Hardly anyone will own up to it now, but back in the heady days of 1997, when Medicare+ Choice was created from an overhaul of the old Medicare risk … Read more

BY JOHN LA PUMA, M.D. Say your sister has breast cancer. Say you’ve heard of BRCA1 and BRCA2, the genes which are mutated in 25 percent of women younger than 45 who get this disease. Say you want to know your risk. Say Alzheimer’s runs in your family–your Dad has it. Say your older brother … Read more

A vaccine against a Few of the most dangerous Clinic germs Can so on Be around. C. difficile infects a sizable percentage of patients in kills and hospitals approximately 15,000 people per year while in the united states alone. Health practitioners may see to the illness with antibiotics, however the bacterium mutates constantly, enabling it … Read more

CMS warns that the slowing economy may force it to reduce Medicare reimbursements to hospitals and doctors…. Texas Insurance Commissioner Jose Montemayor has extracted $9 million in fines and “tens of millions of dollars” in restitution to physicians from health plans accused of not complying with Texas’s prompt-payment law. In New York, meanwhile, the state … Read more

National UTI prevention program gets results More than 600 hospitals participating in the national Comprehensive Unit-Based Safety Program (CUSP), funded by the Agency for Healthcare Research and Quality, reduced catheter-associated urinary tract infections by 32% in non-intensive care units (non-ICUs) between March 2011 and November 2013, according to a study published in the New England Journal … Read more

Formulary Decisions Without Comparative Effectiveness Research Anonymized patient-level longitudinal data better supports formulary policy and coverage decisions, the authors say The United States pharmaceutical market is forecast to grow at a compound annual growth rate of 3.7% from 2013 to 2018. It has been suggested that comparative effectiveness research (CER) may improve the management and … Read more

Michael Levin-Epstein Washington Watch When President Bush decided to halt implementation of an array of regulations promulgated in the waning days of the Clinton administration, most business groups rejoiced and a cadre of advocacy and consumer groups began to mobilize in earnest. But of all the rules put on hold by the new administration, the … Read more

Do more with less — that’s what we all must learn. In the physician’s office, when patients share their doctor’s time, everyone benefits. Shared medical appointments improve patient access, enhance patient and physician satisfaction, and increase practice productivity, all without adding more hours to a physician’s work week. There is even evidence that they promote … Read more

CEO J. Mario Molina, and his brother, CFO John Molina were fired by the company’s board of directors. The announcement, made today, cited the company’s disappointing financial performance, according to FierceHealthcare. The Molina brothers are the sons of the company’s founder, C. David Molina. J. Mario Molina was one of the health insurance industry’s biggest … Read more

It isn’t nearly as comprehensive and trustworthy as the ideal electronic health record, but what’s called the personal health record has its place While federal agencies, policy makers, and provider organizations are promoting the electronic health record as a magic solution for many of the country’s health care system problems, some health plans are taking … Read more

The burgeoning cost of buying health insurance on the ACA exchanges continues as health insurers in the first states to make public filings—Maryland, Virginia, and Connecticut—want to increase premiums by at least 20%, according to Bloomberg News. In Maryland, for instance, CareFirst is asking for a 50% increase in premiums. One of the issues is … Read more

John Marcille Dizzy yet? As if there aren’t enough think tanks poring over and trying to interpret the Patient Protection and Affordable Care Act, here comes another. As we were putting this issue to bed, the National Institute for Health Care Reform, sponsored by automakers and the United Auto Workers, released a study that posits … Read more

The Medical Practioners From the research were writing a lot more prescriptions for medication such as opioid pain killers compared to health practitioners in similar types practicing neighboring – but the letters did not result in fluctuations in prescribing drugs. Still, the study’s lead author said that the outcome can help researchers that are analyzing … Read more

ABSTRACT Objective: To evaluate the effect of 17 alpha-hydroxyprogesterone caproate (17P) on reducing the rate of neonatal intensive care unit (NICU) admissions and premature births in a managed Medicaid population that has a history of preterm delivery. Specifically, to measure the effect of initiating 17P treatment during the recommended time frame of 16-21 weeks gestation versus … Read more

I was just looking at the website of Newtek Business Services (www.thesba.com/), which also goes by the name of The Small Business Authority. It sells financial and administrative services to small businesses. I found more evidence that the public doesn’t have a clue about what’s going on in health care. This is goofy stuff, folks, … Read more

At a glance Vermont Employers Health Alliance Burlington, Vt. Goal: To empower employers to purchase cost-effective health care in a state with limited market options Strategy: Leaves actual purchasing to employers, but is active with educational, lobbying and regulatory initiatives Founded: 1982 President: Jeanne Keller, M.S., A.R.M. Lives covered: 105,000 Back in 1982, when health care purchasing pioneer Willis Goldbeck … Read more

NEWS AND COMMENTARY An American College of Physicians-American Society of Internal Medicine report indicates that people without health insurance have a higher risk of morbidity and early death. The study is an attempt to document what has long been assumed: Lack of insurance is bad for one’s health. Researchers found that the uninsured are 2.4 … Read more

The blood-testing devices that Theranos Inc. has touted as revolutionary often failed to meet the company’s own accuracy requirements for a range of tests, including one to help detect cancer, according to an article in the Wall Street Journal. The Journal got an early look at a federal report detailing deficiencies found by the Centers for Medicare and Medicaid … Read more

The Medicaid managed care business is booming. Look for federal spending to increase from $9 billion last year to $40 billion 10 years from now–a projected growth rate of 14 percent a year. That’s the word from the Congressional Budget Office, which forecasts Medicaid expenditures of $210 billion by 2008. The main reasons: an unexpected … Read more

Name Last modified Size Description Parent Directory 04-Jan-98 21:46 – MC9607.cancel.shtml 16-Mar-97 22:48 10k MC9607.compmon.chart…16-Mar-97 22:48 63k MC9607.compmon.shtml 09-Jul-97 18:03 1k MC9607.contents.shtml 16-Mar-97 22:48 4k MC9607.dealkiller.shtml16-Mar-97 22:48 12k MC9607.editorsmemo.sh..16-Mar-97 22:48 3k MC9607.emergency.shtml 16-Mar-97 22:49 11k MC9607.employer.shtml 16-Mar-97 22:49 5k MC9607.ethics.shtml 16-Mar-97 22:49 8k MC9607.legal.shtml 16-Mar-97 22:49 8k MC9607.malpractice.sh..16-Mar-97 22:49 17k ../../archiveMC/9607/MC9607.news.chart.gif 16-Mar-97 22:49 9k MC9607.news.shtml … Read more

In Corporate America, customer service has moved to the top of the business plan. That’s not to say customer service training has improved — how many times have you dealt with some surly 19-year-old when trying to return something to a store? — but the idea has gotten traction in theory, if not in execution. … Read more

That live attenuated influenza vaccine, also referred to as the”sinus spray” influenza vaccine, if perhaps not be utilized throughout the 2016 2017 flu season. ACIP continues to recommend yearly influenza vaccination, together with the inactivated flu vaccine or recombinant flu vaccine, for everybody else a few weeks and mature. This ACIP vote is predicated on … Read more

Full text available in PDF ABSTRACT This paper has undergone peer review by appropriate members of Managed Care’s Editorial Advisory Board. Purpose: To examine neonatal risk and associated nursery costs for infants with delivery following untreated preterm labor at 34, 35, or 36 weeks’ gestation, by assessing the incidence of neonatal intensive care unit (NICU) admission, … Read more

1990 to help individuals who have emotional health and chemical abuse problems stay participated in their own maintenance. This has been very powerful for those who have HIV too. Is it enlarged for additional chronic problems? The Pandemic of human immunodeficiency virus illness remains a critical general health issue over twenty years after the arrival … Read more

High Speed Internet Migraine Pain Relief fashion trends Credit Card Application Online classifieds Best Mortgage Rates All Inclusive Vacation Packages Paul LendnerPaul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen Expertenstatus nachweisen, liefert er … Read more

States are considering laws that require businesses to provide coverage for their employees. Wal-Mart is the biggest target. John Carroll For years, state legislatures around the country have focused on mandating insurance coverage — specifying what MCOs are required to cover if they want to sell insurance in their states. But after being treated to … Read more

Rising insurance premiums are helping to push U.S. health care spending higher. According to the Health Care Financing Agency, total spending increased 5.6 percent in 1998, up from 1997’s 4.7-percent rise. Various benefit-consulting firms concur that, for the first time in several years, many employers face double-digit premium increases. In addition, an International Society of … Read more

If you would like to submit an article for publication in Managed Care, see our Call for papers. Finding the Value in Value-Designation: Evidence and Opportunity in the United States Sze-jung Wu, PhD; Qinli Ma, PhD; Patricia Martin, RN, BSN; Andrea DeVries, PhD Open vs. Minimally Invasive Hysterectomy: Commercially Insured Costs and Readmissions Kathryn Fitch, RN, MEd; Warner Huh, MD; Andrew Bochner, … Read more

Government overpays specialists relative to primary care physicians and thereby exacerbates the shortage of primary care physicians, according to researchers at the Cambridge Health Alliance and Harvard Medical School. The study, released online by the Journal of General Internal Medicine, will be printed in September. The data are from the 2004 Medical Expenditure Panel Survey, … Read more

Over the past several years, changes in laws and regulations have encouraged greater plan participation and enrollment growth in the Medicare Advantage (MA) private fee-for-service (PFFS) market, according to “The Emerging Role of Group Medicare Private Fee-for-Service Plans” from the Henry J. Kaiser Family Foundation. Legislation such as the Medicare+ Choice program, created by the … Read more

Harvard’s Regina E. Herzlinger says entrepreneurial geniuses will give restless baby boomers what they want: a delivery system in which consumers can choose coverage the same way they shop for cars. Regina E. Herzlinger, Ph.D., is the first holder of the Nancy R. McPherson Professor of Business Administration Chair at the Harvard Business School. An … Read more

Hospitals are hyping better outcomes with the robot, but economics and marketing may be driving the push With three hospitals and 311 beds in small cities in south central Ohio, Adena Health System is not exactly a major metropolitan medical center. But its website does herald Adena Health as the only provider in its region … Read more

Converging forces are an economic train wreck waiting to happen. Avoiding a disaster requires an understanding of the interconnection of health care’s stakeholders and the global consequences of their actions. The cost of our health care system is spinning out of control and no one is applying the brakes. While many “solutions” are being offered, … Read more

The pharmacy director of Blue Cross of Oklahoma shares his company’s success with using three tiers and coinsurance to promote member responsibility. Also available in PDF Drug-benefit design poses a strong challenge to health plans: how to provide stewardship of financial risk and appropriate access, while balancing resources in a competitive environment. Confronting this challenge … Read more

Imagine if we believe as if that our hope isn’t came back? Imagine if our outward symptoms Are disregarded or our narrative thought improbable? What exactly do we do when we believe strongly within our gut that something is wrong inspite of the health care expert who says we’re nice and we are able to … Read more

Washington Initiatives Here’s some unavoidable bad news for hospitals: The Health Care Financing Administration proposes to reduce previously announced Medicare outpatient prospective payments by 4 percent. In a notice published in the Federal Register last month, HCFA says it is obligated, under the Balanced Budget Act, to reduce hospital payments based on an analysis of … Read more

They just take off the brakes the immunity system it strikes cells. But a number of don’t react to check-point inhibitors, and investigators are interested in tactics to conquer the immunity. Even the FDA grants Accelerated acceptance when considered needed to tackle an unmet demand, having a guarantee which post-marketing re-search responsibilities will soon be … Read more

PRACTICE IMPROVEMENT Bob Carlson In 2000, Gregg Omura, MD, saw 20 patients per day. Today, he sees about 30 patients daily, takes home substantially greater pay, and has more satisfied patients, along with a happier staff. “I also feel that I’m not working as hard,” adds Omura, whose family practice is part of Primary Care … Read more

Name Last modified Size Description Parent Directory 04-Jan-98 21:46 – ../../archiveMC/9603/CARESchecklist.gif 16-Mar-97 22:39 70k MC9603.assess.shtml 16-Mar-97 22:39 11k ../../archiveMC/9603/MC9603.compmon.gif 16-Mar-97 22:40 19k MC9603.compmon.shtml 16-Mar-97 22:40 1k MC9603.contents.shtml 16-Mar-97 22:40 3k ../../archiveMC/9603/MC9603.cover.jpg 16-Mar-97 22:40 13k MC9603.editorsmemo.sh..16-Mar-97 22:40 3k MC9603.ethics.shtml 16-Mar-97 22:40 8k ../../archiveMC/9603/MC9603.hmos_helping.gif16-Mar-97 22:40 9k MC9603.legal.shtml 16-Mar-97 22:40 8k MC9603.news.shtml 16-Mar-97 22:40 3k ../../archiveMC/9603/MC9603.outlook.gif 16-Mar-97 22:40 … Read more

Although we all know that change is inevitable and, in health care delivery and financing, highly desired by many stakeholders, most of us prefer evolution to revolution. Revolutions have a habit of being uncontrollable, and most of us want to stay in control as much as we can. Health care cost inflation is the big … Read more

John Marcille MANAGED CARE January 2009. ©MediMedia USA John Marcille You would not be reading this if not for “disruptive innovation” or “disruptive technology,” terms that serve as this issue’s theme. In the magazine business, a disruption called desktop publishing years ago killed jobs, mostly typographers, pressmen, and proofreaders, while reducing costs and allowing many more editorial … Read more

Proponents say ISO 9000 standards are a less prescriptive, ponderous and costly way to review hospitals. But are they truly applicable to health care? Proponents say ISO 9000 standards are a less prescriptive, ponderous and costly way to review hospitals. But are they truly applicable to health care? Nothing sets off shock waves within a … Read more

Hindsight is 20/20, but was this predictable? After a year and a half of hard work, a blue-ribbon commission that set out to keep Medicare from running into a ditch itself slid off the road, thanks to deep ideological divisions regarding government’s role in health care. The commmission disbanded without a recommendation — consigning the … Read more

In a effort that will be watched by health plans and physician associations nationwide, Premera Blue Cross of Washington puts doctors into tiers according to how well they help control costs. Physicians considered most efficient are placed in the lower-cost tier. The Washington State Medical Association’s reaction is that tiering doesn’t make sense without outcomes … Read more

John Marcille If you travel to the south of France, you may find yourself drawn to the lovely scenery in the neighborhood of the Lot River. You may stroll through the streets of a quiet village and let the clean country air fill your lungs. I just hope you don’t get sick and spend most … Read more

Biotechnology companies are doing promising work in producing new organs, with one adult stem cell therapy standing a good chance of approval in Canada According to Organodonor.gov, 108,000 people are awaiting organ transplantation in the United States. Seventy-seven receive a transplant each day, and another 19 die awaiting an organ. The concept of artificial organs … Read more

Legislation & Regulation When a new UCR database is created, how will health plans change their out-of- network payment policies? John Carroll Almost two years ago, Health Net signed off on a settlement of three class-action lawsuits that would have far-reaching — and very expensive — implications for the managed care industry. The health plan … Read more

It’s hard to open any health-related publication these days and not find stories about accountable care organizations (ACOs). Commentary ranges from extolling ACOs as our last, best hope for achieving high-value care in the U.S., to others criticizing ACOs as a thinly disguised return to the 1990s model of managed care and HMOs. While it’s … Read more

The health care economist says that consumers ought to share in the savings from making the right choices. Insurers, providers, and hospitals should make sure that options exist. MANAGED CARE January 2006. ©MediMedia USA A Conversation with James Robinson, PhD The health care economist says that consumers ought to share in the savings from making the right … Read more

The AMA has come out with its strongest condemnation of online prescribing, recommending that action be taken against physicians who prescribe based solely on a patient’s answers to an online questionnaire.The AMA contends that this practice “falls below a minimum standard of medical care.” State and federal agencies are paying more attention to online prescribing, … Read more

Washington Watch Who says the Clinton administration isn’t committed to using whatever forces and resources are necessary to wage war? When it comes to a domestic war against health care waste, fraud, and abuse, the administration isn’t pulling punches. Most industry experts will grant that the administration deserves some credit for gaining what could be … Read more

Chart pages from MANAGED CARE Plastic surgeons ask: What recession?   How much return does that PhD provide?   Pharmacists test payment model based on outcomes   Payers: Expect to feel a double-team pinch   Productivity continues to outpace compensation   School debt can be significant in primary care   California still golden for pharmacists … Read more

Symbiomix Therapeutics today announced the Book of Favorable Period Data from the double-blind, placebo-controlled, multi center analysis were published before printing in the internet version of this American Journal of Obstetrics & Gynecology. Solosec™ can be just a potent, nextgeneration, 5-nitroimidazole antibiotic using enhanced pharmacokinetic properties, also is your earliest and just single-dose oral therapy … Read more

Will 2004 be a healthy year for health insurers? Despite a few caveats, the answer seems to be yes, according to a recent report by Standard & Poor’s, the big rating agency. Operating performance is expected to be strong this year, thanks to moderating medical costs and rate increases that are forecast to run between … Read more

Bundled payment methods happen to be with Us along time, and perhaps it is the right time for you to tweak themaccording to a opinion piece from JAMA. The writers assert that bundled obligations can be more cost-effective in case their durations are enlarged, in case some of those bundled services might be carried out … Read more

Substantial nondrug costs result from switching prescribed medications in response to changes in insurance coverage, and many nonreimbursed costs shift to providers and patients. Full text available in PDF Purpose: Clinicians often are required to switch prescribed therapy for their patients in response to health plan initiatives for controlling drug expenditures. To explore the effect of … Read more

Health plans seek drug review summaries from other plans, vendors, and online sources MargaretAnn Cross Contributing Editor The two dozen medical professionals who make up the pharmacy and therapeutics committee for the Hawaii Medical Service Association are striving to make formulary decisions based on the best evidence available. And like all health plans, the Blue … Read more

A new administration, new funding, and new commitment might help the system realize a long-sought goal John Carroll Over the past few years, hopes for rapid progress in spreading information technology throughout the health care system have been stymied as most small and medium-size physician practices remained on the sidelines. The hefty investment in time … Read more

Back in the days of capitation and other innovative physician payment methods, there was prominent managed care backlash stemming from the potential for conflicts of interest that might keep physicians from recommending expensive but necessary care. A recent study, published in Archives of Internal Medicine , reports on efforts to measure the effect of knowledge … Read more

Warren Surveys talked to about 50 HMOs and community based health plans in 1999 to tally what they were paying physicians in capitation and risk-arrangement contracts. The table indicates what those plans, which had on average 250,000 members, paid to different primary care and specialty physicians. According to Jennifer Marx, M.B.A., a consulting analyst for … Read more

Cardio-respiratory failure will be the main cause of death in Duchenne muscle dystrophy. Dependent on preclinical and period two signs, we analyzed the effectiveness and safety of idebenone in young girls with Duchenne muscular dystrophy that weren’t carrying concomitant glucocorticoids. At a multicentre phase 3 trial in Belgium, Germany, Belgium, the Netherlands, Switzerland, France, Sweden, … Read more

With Congress engineering big changes, plans are likely to face cuts unless legislators take a new approach to fixing the physician pay formula Soon after the Bush administration and Republican members of Congress combined to create Medicare Advantage, the private approach proved to be a solid success with beneficiaries and with the health plans that … Read more

The total immuno-oncology market will be worth approximately $14 billion by 2019, rising to $34 billion by 2024, as the treatment of cancer patients undergoes drastic changes over the next decade, according to GlobalData, a research and consulting firm. The company’s latest report states that the approval and uptake of immuno-oncology products is set to … Read more

Follow this link to PDF version According to Health Risk Management Inc., a consulting company, states with higher quality of care generally have lower per-capita health care costs. HRM’s annual “Quality First” index includes 46 weighted quality indicators that consider what individuals, health care systems, and states do to affect health status and care, and … Read more

Aetna U.S. Healthcare has offered a bare-bones product it says is a step toward reducing the number of uninsured Americans. But a consumer group says Aetna’s Affordable HealthChoices plans would leave patients with huge bills if they needed serious care. The three products pay $50 for a physician visit and $500 or more a day … Read more

Designed to pay for breakthroughs, the new technology add-on (NTAP) ‘bump’ is also too unpredictable, say drug and device groups. When the CMS gave the green light this summer to a breakthrough but high-priced leukemia drug, some may have seen it as a thawing in the agency’s attitude toward new expensive therapies for difficult-to-treat diseases … Read more

It’s A more frequent word of reinforcement you’ll hear from coworkers once they determine you are confronting an ISO audit. Obviously, trusting in fortune isn’t a fantastic strategy for that far online. You ought to prepare yourself every manner possible therefore that fortune wont play in to the consequences. And among the greatest methods to … Read more

Your patient is a young woman whose mother and aunt died of ovarian cancer at ages 47 and 48, respectively. Because of this strong family history, she probably has a 50-percent, rather than a 7- or 8-percent, risk of contracting breast or ovarian cancer. She elects to have a complete hysterectomy based on her “hereditary … Read more

Days Later President Trump Presented an Address on prescription Medication prices Which Has Been Especially light on criticism of Their pharmaceutical industry, His health secretary Monday struck a far more competitive tone, cautioning that the government could be”turning to the pressure” on medication manufacturers. Azar implied that Trump will be quick to predict different medication … Read more

Predicated on EvaluatePharma’s policy of over 7,000 of the world’s major biotech and pharmaceutical companies, that the Orphan Drug Report 20-19 highlights trends in pharmaceutical earnings of antipsychotic drugs, US expense of therapy, leading goods From the infrequent diseases landscape and orphan drug designation investigation from treatment and region area. Illness. The good results of … Read more

Mentors and support groups can help you avoid being fired. And if the worst does happen, they can facilitate your comeback. Arthur Lazarus, MD, MBA Most chief executive officers who work in health care say they will retire soon and expect it will be a struggle to replace them due to a shortage of qualified … Read more

Mylan keeps reason for rejection under wraps Mylan has reported on the status of its abbreviated new drug application with the FDA for its generic version of GlaxoSmithKline’s Advair Diskus (fluticasone propionate and salmeterol inhalation powder). The company states that it has received a complete response letter (CRL) from the FDA and is in the … Read more

In a rare admission, the president and chief executive officer of Aetna U.S. Healthcare says that when it came to contract negotiations, the insurer played too much hardball with physicians in Texas. The company’s contracting tactics fueled a physician backlash that led several groups in the state to walk away from the HMO when their … Read more

Think you know everything physicians should consider when they take on a capitated contract? You may be surprised by what you learn from this practice-management consultant’s succinct advice. Whether you’re ready or not, capitation is coming to your neighborhood–if it hasn’t already moved in. Under capitation, of course, an HMO or other managed care organization … Read more

Better comprehension of viral sciences and the roots of both influenza epidemics and pandemics can improve identification and disease control. Advances to halt the spread of disorder, including live-attenuated and inactivated vaccines and brand new antifungal agents, promise to reduce illness burden, mortality, and morbidity. One of a total of 72314 case records, 44672 were … Read more

Other caregivers on the previous few decades, a new research suggests. Researchers examined data collected between 1987 and 2010 from greater than 30,500 caregivers all over the nation, including almost 6,300 physicians, also discovered that the median annual income one of the health practitioners was $143,963 throughout 1987-1990 and $157,751 throughout 2006-2010. That is a … Read more

At Some time when the United States of America is in the Grasp of opioid Outbreak , Many carriers are restricting usage of pain medications that take a lesser probability of addiction or addiction, even because they provide relatively simple accessibility to generic antipsychotic medications. The reason why, experts state: Opioid medication are generally economical … Read more

John Carroll For the past two years states have been caught in the proverbial hard place; wedged in between weak tax revenue and brutal hikes in the cost of their Medicaid programs. For state lawmakers, the dilemma has focused a glaring spotlight on one key cost item that has been spinning out of control: prescription … Read more

MANAGED CARE July 2008. ©MediMedia USA The United Kingdom’s National Health Service came under fire recently when it chose one vaccine to prevent cervical cancer over a rival. The vaccine program, which will protect young girls who might develop cervical cancer later in life, will dispense Cervarix, a vaccine that offers immunity to human papilloma virus (HPV) … Read more

Health plans see value in rewarding physicians for participating in their specialty boards’ maintenance-of-certification programs A board-certified cardiologist or internist or pediatrician used to be like the Pope: The physician passed a test just once, early on, and carried the “board-certified” designation for life, no requalification or retesting required. Board-certified physicians who are held to … Read more

In a new report, the Senate’s Special Committee on Aging examines the business model used by these companies; assesses the impacts of price hikes on patients, payers, providers, hospitals, and governments; and discusses potential policy responses. The committee discovered that each of the four companies followed a business model that enabled them to identify and … Read more

Hard-charging New York Attorney General Andrew Cuomo says reported rates are neither usual nor customary, nor are they reasonable John Carroll For investigators in the New York attorney general’s office, the evidence seemed clear that UnitedHealth Group was running an insurance scam. They had a succinct example to demonstrate how it worked, too. Their research … Read more

When a pharmacist — for personal beliefs — refuses to fill a prescription, the health plan should be very concerned. The reason we evolved with two ears is because we survive better if we can hear two sides of an argument. This talent comes in handy in analyzing the ruckus over pharmacists refusing to provide … Read more

Single daily pill combines hypertension, cholesterol drugs Taking one daily pill that combined medications to treat high blood pressure and high cholesterol lowered heart disease risk among underserved patients better than taking several separate medications to treat these risk factors, according to new research published in The New England Journal of Medicine. Researchers found that … Read more

Health plans are the pioneers of coordinated care, says Karen Ignagni, president and CEO of America’s Health Insurance Plans, and have led the way in health care through innovation. Therefore, they are not likely to go out of business; it’s more likely that they will continue to innovate, she says. “To say that health insurers … Read more

HEALTH CARE TRENDS Minority groups offer a large untapped market right within our national borders. Health plans and physicians need to develop the tools to serve it. Health care providers throughout the United States — from small medical groups to managed care organizations like Kaiser Permanente — all face the same changing demographics and market … Read more

Hospitals under financial pressure could battle to keep quality and patient safety also have worse patient outcomes in accordance with well-resourced hospitals. Poor predictive legitimacy could explain why previous studies on the institution between financing and quality/safety are equivocal. This manuscript applies primary component analysis to make solid steps of the monetary status and quality/safety … Read more

The Mountain Named JCAHO Meets the Tremor Called ISO Proponents say ISO 9000 standards are a less prescriptive, ponderous and costly way to review hospitals. But are they truly applicable to health care? Autopsy Reveals Patient Rights Legislation May Have Been Dead for Several Months PSOs: What Happened? The government had hoped that PSOs would … Read more

A disease management program by any other name might go belly up — pronto. But there are ways to avoid the quick fizzle. The best-laid plans of HMO executives can fizzle — especially if those plans involve disease management. Every year DM programs are launched and quickly die. Nobody knows just how many go belly-up, … Read more

Working quickly, President Bush has drafted the first half of his prescription drug plan for Medicare and sent it to Congress. But the so-called “immediate helping hand,” a short-term block grant program to subsidize prescriptions for low-income beneficiaries while Congress works out a permanent benefit, has few supporters in Congress. Both parties want to decide … Read more

SPECIAL REPORT: HMO LIABILITY Liability’s Jaws Closing on HMOs Denials of care are coming back to bite. Prepare for the inevitable. How HMO Did Right but Lost Anyway A Humana VP writes about the Karen Johnson case. Will Insurance Cover Punitive Damages? A lawyer looks at why HMOs could be left holding the bag. External … Read more

The Trump Government on Wednesday return into its pledge to resist high U.S. drug deals with a strategy to limit the low cost cost for insulin, even a life threatening medicine, to $ 3-5 a month to get several individuals who have diabetes that are signed up for Medicare. The Center for Medicare and Medicaid … Read more

The health plan was listing badly when Charles Baker boarded it in 2000. Since then, the ship has been righted and the way is clear. Shortly after becoming chief executive at Harvard Pilgrim Health Care five years ago, Charles Baker felt more like a frustrated enrollee than the guy in charge. For several weeks, he … Read more

By MARK D. ABRUZZO, J.D. In Managed Care’s November 1999 issue, Al Lewis, president of the Disease Management Association of America, wrote about potential pitfalls facing DM. One identified by Lewis was state privacy laws, a topic that merits further attention. When the Health Insurance Portability and Accountability Act became law in 1996, it was … Read more

Consider the financial effect of the expansion in associations at 2016 and 2017 and the gaps between centers which lived in nations which did and failed to enlarge Medicaid. “ministry in growth states continued to undergo decreased uncompensated care expenses and raised Medicaid revenue and monetary gross profits,” the research said. “The size of these … Read more

Fifty is a nifty number when considering how to cut back the care given in emergency rooms for nonemergency problems, according to a recent study. It seems that levying a copayment of $50 or more results in a significant reduction in ER use for non-emergent conditions. “Copayment Levels and Their Influence on Patient Behavior in … Read more

Uncle Sam isn’t too sure that disease management saves money in the managed care world, and has some real doubts that it could ever be applied to Medicare. At least, those are the findings of a Congressional Budget Office study that has proponents, critics, and observers of DM talking. The report resulted from a congressional … Read more

Thanks largely to the spread of managed care, medical schools are minting increasing numbers of physicians who eschew specialty practice for primary care. Now, according to the AMA, primary care physicians are beginning to gain financial rewards for their choice, although their pay still lags behind that of specialists. Mean net income for general and … Read more

Agreement to get Omthera Pharmaceuticals, a specialty pharmaceutical company located in Princeton, nj, dedicated to the development and commercialisation of new treatments for abnormal amounts of lipids from the bloodstream, called dyslipidemia. Omthera’s investigational Solution, EpanovaTM, to its possible Treatment of patients who have very substantial levels, is just a publication omega3 free fatty acid … Read more

VBID is a promising approach to improving health and cost outcomes, but its use has been limited. Expanding it to complicated interventions will require a lot of effort. The history of managed care is littered with the debris of failed ideas. Capitation, anyone? It led directly to the managed care backlash. Remember provider-owned HMOs? They … Read more

Brand-name manufacturers and many neurologists see danger in generic substitution, but the FDA insists that the practice is safe In the war between brand-name drug companies and generics manufacturers, each side is almost religious in its orthodoxy and intransigence. The ground they fight over is the patient. On one side are the large pharmaceutical companies, … Read more

Insurers need a coverage strategy that focuses on reducing post-surgical complications and avoiding adverse selection Despite a national obsession with weight loss, Americans continue to get heavier. There are numerous contributing factors, including increased portion sizes, greater fast food availability, and decreased daily activity. Obesity is often emphasized from a cosmetic perspective, but we are … Read more

Requiring some patients with chronic conditions to try and fail multiple medications leads to complications and drives up costs, say many physicians. Insurers answer that the trial-and-error approach can be an important way to rein in costs. Step therapy can sometimes be a step backward. For instance, take the case of Eitan Kling-Levine, whose gastroenterologist … Read more

Pay tied to performance has become the norm outside of managed care. Now, the industry wants the same for its captains. John Carroll Contributing Editor Ask Milton Wood about executive compensation in managed care these days, and you hear a lot about metrics. For 33 years, he says, his company — M. Wood — has … Read more

Though the clock is ticking for HMOs to comply with new privacy guidelines under the Health Insurance Portability and Accountability Act, indications are that many companies are confused about what they need to do.The deadline for most health care companies is Oct. 16, 2002 (see related story). The National Council for Prescription Drug Programs surveyed … Read more

Full text in PDF ABSTRACT: The purpose of this study was to corroborate an earlier study that explored the relationship between a health plan’s Health Plan Employer Data and Information Set (HEDIS) score for glycolated hemoglobin (HbA1c) control in diabetes patients and its utilization of insulin and oral diabetes products. Prescription volumes were tracked for four … Read more

When it comes to runaway medical costs, the United States isn’t the only country with a problem. In a survey conducted by Watson Wyatt involving 85 insurers to global employers throughout Asia, Africa, Europe, and the Americas, 71 percent of respondents said they expect higher or significantly higher medical costs over the next five years, … Read more

The physician patient relationship has been and remains a keystone of attention: the moderate where data will be accumulated, analyses and strategies are all created, compliance is realized, and also healing, patient abuse, and service are all supplied. To manage associations, its importance rests on the market educated: gratification with a physician –patient relationship can … Read more

To answer this query quite I achieved to somebody who manages the ability creation of over 100,000 employees employed in consulting to acquire yourself a wellrounded outlook. He studied his very first occupation was legal consulting. My dialog with him revolve around understanding what young professionals ought to be aware of whether they are taking … Read more

Putting out a trade publication doesn’t mean losing sight of just how energizing “hard news” can be. True, our brethren in the mainstream media get to hang their passion on a different headline each day, from the serious (an Iranian strongman’s visit) to the silly (Lindsay’s in rehab again!). But name a field that’s more … Read more

Hospitals and physicians, to varying degrees, are finding that doing the right thing is good business practice Maureen Glabman Contributing Editor Three years ago, Kaiser Permanente executives approved a daring pilot program at six medical centers in three states. When patients had disappointing outcomes, doctors who took a communication course delivered heartfelt, empathetic apologies. If … Read more

The Gardasil 9 prevents certain ailments and infections due to the two HPV types included in the vaccine. Gardasil, A vaccine approved by the FDA from 2006 to stop certain ailments and diseases due to four HPV types, is nolonger distributed in the U.S.. In 2014the FDA approved Gardasil 9, that covers the exact same … Read more

The latest data on median gross charges, which are the charges, at undiscounted rates, of all services provided (also called productivity), indicate that primary care physician productivity is still increasing faster than compensation. Back in 2002, the opposite was true — compensation was growing slightly faster. According to the “Physician Compensation and Production Survey” issued … Read more

Data support Obamacare’s Hospital Readmission Reduction Program Readmission rates declined after the announcement of the Hospital Readmission Reduction Program (HRRP), which penalizes hospitals for excess readmissions for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia, according to a study from the Yale School of Medicine. The findings were published in the Journal of … Read more

An examination group from Duke Wellbeing has fostered a counter acting agent from the body’s own invulnerable framework that specially assaults disease cells. The immunizer works by focusing on a characteristic protection instrument that malignant growth tumors abuse. In a paper distributed in Cell Reports, the Duke group depicts the activities of a malignant growth … Read more

Percentage of business owners with fewer than 200 employees who say that the following are very important when choosing health coverage: Color chart SOURCE: HEALTH BENEFITS OF SMALL EMPLOYERS, KPMG PEAT MARWICK FOR THE KAISER FAMILY FOUNDATION, 1999 Paul LendnerPaul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit … Read more

By Allen D. Spiegel, Ph.D. AT THE DAWN OF CIVILIZATION, about 4,000 years ago, nomadic Semite tribes developed a managed health care system. Using cuneiform, a hieroglyphic writing, they inscribed the concepts on clay tablets and chiseled them into stone between the 17th and 21st centuries B.C. Adapting the existing edicts, King Hammurabi of Babylon … Read more

While local governments ponder just what course to take, health plans prepare to grab as much market share as possible Just days after the nation handed the Obama administration another four-year lease on the White House, regulators at the Department of Health and Human Services rolled out an important new set of rules to govern … Read more

Good news for government workers enrolled in the Federal Employees Health Benefits Program. Premiums are expected to increase 7.9 percent next year. This after five consecutive years of double-digit hikes…. PPO demonstration projects for Medicare in 2001 and 2002 may have benefited by CMS officials exceeding their legislative authority, according to a General Accounting Office … Read more

When does a characteristic become a disorder? The next edition of the Diagnostic and Statistical Manual of Mental Disorders means even more coverage decisions. Last May, members of the American Psychological Association turned up at a gathering in Hawaii to review some of the fine points related to diagnosing hypersexual disorder, a condition that some … Read more

Attendees at the CMS Health Care Quality Conference were presented with this hypothetical: Your teenage daughter wants to drive. You give her books, perhaps an online exercise or two, and then test her. She gets an A. “How many of you would be satisfied that your daughter is ready to drive?” Sanjeev Arora, MD, asked … Read more

Lawmakers criticize calculations Responding to concerns raised by hospitals and a majority of House and Senate lawmakers, the Centers for Medicare and Medicaid Services (CMS) has announced that it will delay until July the public release of an overall hospital quality star rating, according to a report from the American Hospital Association. The ratings were … Read more

Though factor, the price of running an RCT is often as large as $1 billion, putting into consideration their feasibility for every healthcare intervention. Additionally, the wider application of RCT outcomes was subject to scrutiny, considering the underlying selection bias. Greater than 5 percent of elderly patients with cancer take part in clinical trials, and … Read more

An Analysis of heart failure Could seem daunting, especially when it Comes unexpectedly. But heart-failure is manageable and also, for a lot of , heart failure treatment could be the launch of a fresh, healthiest period of life. That is since the very first step to managing this problem is to produce sure life style … Read more

A review of the AMA’s model managed care contract shows an attempt to get the health plan out of the driver’s seat — or at least to share the controls. The AMA apparently believes that physicians have little bargaining power, and has drafted a model managed care medical services agreement to redress this situation. The … Read more

Historically, primary attention was underfunded in the USA. With no significant mass of debtors, investments in primary care produced by individual donors –Shifting just their individual part of a clinic’s patient population–may not offer adequate funds to that practice-wide changes required to alter primary attention. CPC was made to tackle this impasse through multi-payer cooperation. … Read more

Adults between 19 and 29 are one of the largest and fastest-growing segments of the U.S. population that lack health insurance, according to a new report from the Commonwealth Fund. Young adults lose coverage at 19 or upon high school or college graduation, and nearly 40 percent of college graduates and 50 percent of high … Read more

Drugs for comorbidities cost far more than the drugs for the condition itself At an annual cost of nearly $85 billion, the 4.5 million who suffer from Alzheimer’s disease in this country place great strain on the nation’s health system. Significantly affected are managed care plans that participate in Medicare. The number of Alzheimer’s patients … Read more

West Virginia Gov. Cecil H. Underwood last month unveiled a disease management program to control Medicaid prescription drug costs. The governor chose the new program instead of a formulary, which a study group he appointed had proposed. The National Pharmaceutical Council, a not-for-profit organization funded by a group of drug manufacturers, will provide $500,000 for … Read more

Results concur that rozanolixizumab was tolerated across all dosage groups, in keeping with all previous rozanolixizumab research studies. The most frequently reported adverse event was headache, together with mild-to-moderate headaches found at higher dosages; additional reported adverse events included nausea and diarrhea. These events were usually of short term and also most events resolved with … Read more

“Physicians are always amazed when I tell them that only 50 percent of their work day is productive time,” says Sherry Delio, an expert in clinical practice work flow and efficiency. “They say, ‘I can’t believe that. I worked all day.’ I say, ‘Yes, but you had a lot of waits and delays.’” Delio, director … Read more

They are bigger than ever. Specialty pharmacy drugs have made their bargaining power more important than ever. Do the P and B in PBM stand for power broker? When Express Scripts announced last December that it had negotiated a discount with AbbVie for Viekira Pak, the company’s hepatitis C drug, it caught the health care … Read more

Medicine is a recession-proof occupation, which is good, since we don’t know how long the current downturn will last. And consider this: The Bureau of Labor Statistics says that from now to at least 2016, anyone with an MD after his or her name will be greatly in demand. “In addition to job openings from … Read more

The goal of diabetes management is maintaining glycemic control while targeting quality of life improvements Overwhelming recommendations from the literature indicate that the major goal of diabetes treatment and management is aggressive glycemic control. Diabetes is highly prevalent; it is currently at 20.8 million, or 7 percent of the United States population. Prediabetes is also … Read more

Retrospective Cohort Study of Medication Adherence and Risk for 30-day Hospital Readmission in a Medicare Cost Plan Angela K. Hochhalter, PhD ; Rashmita Basu, PhD ; Karim Prasla, PharmD ; Chanhee Jo, PhD Fixed-Dose Triple-Combination Treatments In the Management of Hypertension C. Venkata S. Ram, MD How Does Management of Echocardiography Affect Use Across Risk Groups? Andrea DeVries, PhD ; Gosia Sylwestrzak, MA ; Abiy … Read more

Multiple Sclerosis: New Perspectives on the Patient Journey–2019 Update Summary of an Actuarial Analysis and Report Download Supplement Paul LendnerPaul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen Expertenstatus nachweisen, liefert er unseren Lesern … Read more

Don’t look now but the only thing falling in terms of health care costs seems to be the rate of increase of premiums — good news for employers and other purchasers. Preliminary results from the 2006 Group Health Insurance Survey indicate the lowest average premium increase in seven years. In fact, this is the fourth … Read more

The French wellbeing unites worldwide policy with a people –private mixture of hospital and healthcare and a bigger amount of service supply compared to at the USA. Even though system is not even close to perfect, its own indications of health status and user satisfaction are high; its own costs, as a share of gross … Read more

A lot of people appear willing to pay pharmacies for medication therapy management (MTM) services, according to a survey reported in Consultant Pharmacist. Participants in three Florida cities and were asked if they would be willing to pay for certain services based on the proportion of the payment that would be out of pocket, and … Read more

A peptide fusion protein can stem the tide of abnormal, excessive bleeding Thomas Morrow, MD Platelets are amazing components of our bloodstream. Not actually cells (they lack a nucleus and major metabolic machinery) and available in large quantities, they respond in a moment’s notice to a leak in our blood vessels to prevent catastrophic bleeding. … Read more

The current underwriting cycle is long in the tooth, but experts still see profitability ahead The laws of physics make clear that what goes up must come down. But recent history suggests that the underwriting cycle for health insurance may prove to be an exception — we no longer know exactly when, or if, those … Read more

It’s Just That Simple After grand rounds this morning at the University Medical Center at Princeton, the director of the recently created transitional care program, Kathleen H. Seneca, MSN, was speaking with one of our nephrologists about the purpose of the program. It fills the transitional gap for people discharged from the hospital that do … Read more

The US healthcare system is in crisis, with documented gaps in quality, safety, access, and affordability. Years of escalating costs— which will be pushed even higher by new medical advances1 —have not always paid off in terms of better quality or outcomes.2 In short, we pay more than any other country for healthcare, but get … Read more

As Preferred provider organizations been the dominant version of managed medical care from the private industry, policy makers have viewed PPOs being a stylish solution for Medicare. Within the following column, we examine PPOs have worked thus far under the demo, for example PPO accessibility and market entrance; premiums, benefits, and beneficiary cost sharing; along … Read more

All the focus on accountable care organizations might be overkill, considering that participation is voluntary. Health plans face other deadlines, however. For instance, the clock is running for insurers to plan and prepare for transition to the ICD-10 coding system. The compliance date is Oct. 1, 2013, and the preparation involves a lot of work: … Read more

Fallout from the Medicare Modernization Act promises to rain down for years to come. Among many other things, the MMA created the Citizens’ Health Care Working Group to encourage Americans “to engage in an informed national public debate to make choices about the services they want covered, what health care coverage they want, and how … Read more

A straightforward method of identifying potentially non-urgent ED visits from administrative data can be employed to calculate population-based rates, which might be applied in the development of managed care programs Full text in PDF Abstract Purpose: Studies worldwide in emergency departments (ED) find that a substantial proportion of patients seek care for non-urgent conditions. Managed care … Read more

Though ROI is hard to calculate, insurer says that its on-site clinics are changing employee behavior for the good When Tufts Health Plan opened its Be Well Center for its own employees in February, it did so as a self-insured company, the kind that tends to rely more on clinics than those that aren’t self-insured. … Read more

By Martin Sipkoff Contributing Editor The actor in the videotape speaks directly to the health plan member, who recently was diagnosed with coronary artery disease. The actor says that CAD is the most common cause of death in America: 12 million suffer from it, and 500,000 sufferers die every year. “Although choosing a treatment may … Read more

While plans, hospitals, and physician groups talk the talk, the Veterans Health Administration is walking the walk In 1990, ABC News “Primetime” won an investigative reporters and editors award for a hidden camera account of patient neglect, abuse, and unsanitary conditions at a Veterans Health Administration hospital in Ohio. That same year, JCAHO found that … Read more

Medical direction companies (MSOs) from meddling together and effortlessly, directly or indirectly, restrain or somehow affecting, the cases of health clinic. The task is the health venture handled by able healthcare professionals would rather call these shots. Even the non-physician entrepreneur wishes the health venture, makes it financed, even amateurs it with all the ideal … Read more

Chart To stay competitive, Medicare HMOs have added supplemental benefits, including pharmacy, to their basic plans. But last year, the share of Medicare plans offering prescription-drug coverage declined slightly; demand-driven expense has forced many HMOs to re-evaluate the pharmacy benefit. One of the industry’s solutions: No Medicare HMOs will have a zero-copayment for the pharmacy … Read more

The National Institutes of Health stopped a cardiovascular clinical trial early for lack of benefit. The trial was halted after it was determined that a combination treatment of a statin with Niaspan didn’t reduce the rate of heart attacks, strokes, heart-related hospitalizations, or the number of procedures needed to improve blood flow in the arteries … Read more

The rising cost on prescription drugs is a large concern for users At the USA. As a result of rising consumption of drug expenses, Americans, particularly older and the prosecution, stay away from taking medications or bypass dosages. As per research, 22 percent of seniors don’t fulfill their prescriptions because they can’t pay the expense … Read more

Experts at three PBMs say watch out for several recently approved and expected-to-be-approved medications Specialty medications will continue to dominate the pharmacy benefits landscape next year. “Several new breakthrough drugs — incredible medications for patients — have received recent approval and more are anticipated in 2015,” says Sharon Frazee, vice president for research and analytics … Read more

Current practice guidelines suggest that certain low-risk patients with pulmonary embolism (PE) can be treated in the outpatient setting, but physicians rarely follow them. A new randomized, multicenter study shows that outpatient care can sometimes be used in place of inpatient care — reducing hospitalizations and costs. “The findings support a shift in clinical management … Read more

Tune your dial to National Public Radio, flip to Harper’s May cover story, or read the New England Journal of Medicine’s editorials about nonprofit and for-profit health plans and you realize that the bottom line is at the top of everyone’s mind these days. The opinions of economists, executives and practicing physicians are igniting a … Read more

They are expected to survive and possibly even thrive no matter what form the health system takes under the Trump administration. When the dust finally settles on congressional Republicans’ seven-year quest to repeal and replace the ACA, who knows which parts of the law will survive and which won’t? But the ACO, a creature of … Read more

Abstract Purpose: Minimally invasive surgery is associated with improved clinical outcomes and reduced costs. We hypothesize that in patients with similar preoperative characteristics, hysterectomy, colectomy, and thoracic resection performed via minimally invasive surgery (MIS) approach would be associated with fewer complex Diagnosis Related Group (cDRG) assignments and subsequently result in reimbursement savings. Methodology: Premier hospital database was … Read more

MANAGED CARE October 2010. ©MediMedia USA Its new branding campaign may be a ‘right mistake’ Thomas Reinke “We made too many wrong mistakes,” is one of the many “duh” quips attributed to Yogi Berra. But it could also be an insightful analysis of the many attempts of pharmacy benefit managers (PBMs) to connect with patients. “Historically PBMs … Read more

As enrollment increases in consumer-directed health plans, some insurers find a little guidance goes a long way Lola Butcher A swim coach helps swimmers minimize their turn times. A hitting coach helps baseball players develop a powerful swing. A health coach helps . . . well, that depends on whom you talk to. Insurers, consultants, … Read more

Some State Medicaid Programs Still Block or Limit Hep C Drugs ED SILVERMAN Restrictions blunted the effect of Sovaldi and other antivirals on Medicaid budgets. The gradual removal of these barriers is going too slowly, say advocates. For Managed Care, the Future Looks Rosy if… TIMOTHY KELLEY Managed care can survive and may even thrive, … Read more

Also available as PDF Most physician and lay managers in group practices saw modest compensation increases from 1997 to 1998. Medical directors, however, proved the exception, as their median compensation level fell 14 percent. A breakout of the data indicates that the more time spent on administrative duties, and the greater the share of practice … Read more

BY NEIL CAESAR, J.D. From time to time we have discussed how important it is for physicians to consider the Ethics in Patient Referral Act (the so-called Stark law) when crafting an income division or compensation formula. This law prohibits physicians from dividing income among themselves in a way that tracks their utilization of certain … Read more

Employer Groups to Hospitals: Your Prices Are Too Darn High! A Rand report showing that some hospitals charge 200% to 300% more than Medicare pays has sparked a new effort among employers to push hospitals to cut what they charge for care. Hospital leaders say price is only part of the story. Imagine being a … Read more

A handful of leading PPOs have agreed to test the National Committee for Quality Assurance’s first tool for measuring PPO quality of care. NCQA modified its Consumer Assessment of Health Plans Survey, which it has used as part of HEDIS to report member satisfaction with HMOs. The revisions to the survey will allow PPO enrollees … Read more

With a growing population, the prevalence of systemic lupus erythematosus (SLE) cases in the United States is expected to rise. Datamonitor compiled epidemiologic prevalence data for seven countries — the United States, Japan, France, Germany, Italy, Spain, and the United Kingdom. The largest increase in SLE cases is expected here in the United States, especially … Read more

BY PETER WEHRWEIN The Balanced Budget Act of 1997 tied the fate of the $200 billion Medicare program to managed care. In theory, Medicare and managed care were made for each other. But how will it work in practice? The knot was tied Aug. 5, 1997. President Clinton officiated. By liberalizing several key rules, raising … Read more

MANAGED CARE July 2008. ©MediMedia USA The Commonwealth Fund has advanced a plan that it says would insure 44 million of the estimated 48 million uninsured Americans and would offer new health insurance choices to individuals and small businesses for 30 percent less than what employers pay now. Dubbed the “Building Blocks” plan by the Commonwealth Fund, … Read more

A Quiz: Name That Health Care Model Steven Peskin, MD What do these characteristics bring to mind? Flexible appointment scheduling Advanced electronic communication Care coordination Counseling and education Electronic prescribing Electronic health record with patient portal If you thought Level 3 Medical Home, you were correct. If you thought retainer (concierge) practice, you would also … Read more

Physicians can earn extra money, but hospitals can lose if they do not show an improvement in quality Frank Diamond Managing Editor MANAGED CARE December 2010. ©MediMedia USA Physicians can earn extra money, but hospitals can lose if they do not show an improvement in quality Frank Diamond Managing Editor One of the many changes wrought by … Read more

New data have supported the safety and tolerability of Belbuca (buprenorphine) buccal film (Endo Pharmaceuticals) for the long-term management of chronic pain in patients requiring around-the-clock opioids. The findings will be presented at the International Conference on Opioids (ICOO 2016) in Boston, which takes place on June 5–7. Belbuca is a mu-opioid receptor partial agonist … Read more

A CDC program shows that diabetes prevention works. Solera hopes to link up health plan enrollees with digital and community-based prevention programs. Thomas Morrow, MD Tweet Widget (link is external) My “times have changed” file seems to get bigger by the day. When I was a medical student more than 40 years ago, we were … Read more

In theory, consumer-directed health plans put the reins of decision making into the hands of their members. But medical management departments are alive and well inside CDHPs — and may even expand under these plan designs. By MargaretAnn Cross Contributing Editor A member signing on with a consumer-directed health plan may be attracted to the … Read more

Although lower income in rural areas is often cited as an obstacle to recruitment of physicians, one study suggests rural and urban areas do not differ significantly — at least, in terms of income. Moreover, after adjusting for differences in cost of living, hours on the job, specialty, and other factors, rural doctors on average … Read more

A review of health care reform bills proposed by Congress shows that many of them would cover more uninsured Americans than the current administration proposal. The review, conducted by the Lewin Group on behalf of the Commonwealth Fund Commission, determined that in addition to reducing the number of uninsured Americans, the proposals would also decrease … Read more

Neil Caesar, J.D. Managed care is forcing physician groups to guard their alliances zealously, and one way to do this is with noncompete clauses in physician contracts. Such clauses can help medical groups protect themselves generally against the threat of a physician employee departing with a host of patients that he or she acquired only … Read more

FEATURE Tools for Taking the Measure of Cancer Drugs How much is a cancer medication really worth? The answer can depend upon whom you ask. But now, there is a new pair of tools to help sort out this vexing and contentious issue. One is a website that serves as an online calculator that can … Read more

Michael S. Victoroff, M.D. Recent studies have measured the length of time doctors and patients spend together in the exam room. Contrary to urban legend, the duration of primary care office visits has not shortened over the last decade. It has slightly lengthened, with HMO patients having longer visits than patients with other kinds of … Read more

Almost 70 percent of 406 human resource executives in a national survey believe that larger investments in wellness programs will help curb health care costs. The main targets of those efforts should be obesity, mental health, and a too-sedentary lifestyle, according to the survey by the Society for Human Resource Management. Eighty-four percent of employers … Read more

As of March, about 7 percent of the 560,400 office-based physicians in the United States were actively writing electronic prescriptions, and about 73 percent of the 57,500 retail pharmacies were actively receiving them. By the end of 2008, the number of e-prescription transactions will reach 100 million, according to the Pharmacy Health Information Exchange, which … Read more

Healthy Blue Living in Michigan lets employers and members reap the benefits of lifestyle improvement When Blue Care Network, the affiliated HMO of Blue Cross Blue Shield of Michigan, launched its wellness program five years ago, company officials were momentarily surprised by how quickly the effort grew, says Marc Keshishian, MD, Blue Care Network’s senior … Read more

Hospitals have reacted sharply to a proposed rule from the Centers for Medicare and Medicaid Services (CMS) to remove most Medicare nonemergency off-campus health services from the Outpatient Prospective Payment System (OPPS). The rule would implement Section 603 of the Bipartisan Budget Act of 2015 and is expected to save approximately $500 million a year, … Read more

In response to the expense of new migraine therapies, treatment practices aimed at controlling direct costs are now the norm. Full text of this article is available in PDF. Abstract Migraine headache is a disabling disease that poses a significant societal burden. Stratified care and early intervention are current strategies for migraine management. It has … Read more

Results of the implementation of a step therapy edit that required HMO members to use a generic antidepressant, excluding tricyclic antidepressants, before using a brand-name antidepressant resulted in drug cost savings of 11.7 percent for the entire class of antidepressants. That worked out to 36 cents per member per month. The step therapy edit applied … Read more

The switch to EDI’s 5010 data interchange standards requires full readiness — called level 1 by those in the know — in 21⁄2 years. Let the scrambling begin. John Carroll When the Obama administration moved into the corridors of power in Washington D.C., there was a brief period of uncertainty over new deadlines for the … Read more

The pendulum has swung back and forth on hormone replacement therapy. Bespoke and supposed more ‘natural’ hormone combinations put together by compounding pharmacists have become popular. Mainstream endocrinologists see compounding as risky, partly because the practitioners who prescribe it may not see the dangers. JoAnn Pinkerton, MD, a gynecologist whose medical practice focuses on women’s … Read more

When Tim Stezzi and Tim Search launched Managed Care in 1992, the backlash against its eponym was in full swing. Hundreds of bills had been introduced in state legislatures the year before to curb the perceived excesses. Utilization review was being questioned, gatekeeping disparaged.  “It… Q&A; Weighing the Future of Value-based Care: You Need Scale … Read more

Substance abuse is an underlying cause or exacerbation of many health problems, but physicians are reluctant to confront patients A disease affecting 8 percent of working adults is underdiagnosed and undertreated. The disease ravages bodies, workplaces, and the health care system, and adds billions to the cost of health care each year. It’s a behavioral … Read more

Predictive biomarkers are revamping drug development and breathing new life into old and failed drugs. But this re-thinking of what works, in who, and why raises questions about cost and accessibility. Precision may be pricy. Michael D. Dalzell 3 off the scrap heap Michael D. Dalzell Call it repurposing, repositioning, or recycling, it’s a fast-growing … Read more

After an FDA advisory committee called for stronger warnings to health care providers that some children and teenagers can become suicidal when prescribed antidepressants, the percentage of eligible patients taking these agents dropped considerably. Medco Health Solutions reports an 18 percent decrease in the number of pediatric patients taking an antidepressant in the first quarter … Read more

AMA Survey: Patient Clinical Outcomes Shortchanged by Prior Authorization   New collaborative opportunities underway to create change More than nine in 10 physicians (92%) say that prior authorizations programs have a negative impact on patient clinical outcomes, according to a new physician survey released by the American Medical Association (AMA). The survey results further bolster … Read more

John A. Marcille If the White House indeed takes on tort reform this year, it will be interesting to see if any meaningful legislation results and what effect it might have on health care. Doctors in this litigious age tend to practice defensive medicine, and that means more use of expensive imaging technology — as … Read more

Though there are challenges to serving the elderly, movers and shakers say that they should be able to cut costs in pilot populations by 5 percent. John Carroll Medicare has been working hard to become disease management’s new champion. And its newly rolled-out DM pilot program for fee-for-service beneficiaries offers much to win — and … Read more

Formularies, one of managed care’s favorite cost-control tools, may not be doing the job, according to a new study led by outcomes expert Susan Horn, Ph.D., senior scientist at the Institute for Clinical Outcomes Research in Salt Lake City. What Horn and fellow researchers discovered surprised them and will surely stun managed care executives: Restrictive … Read more

FDA is advising the the Acute Unwanted effects associated with Fluoroquinolone antifungal drugs usually outweigh the benefits of patients who have severe hepatitis, acute influenza, and simple urinary tract ailments that have other treatment choices. For patients using those requirements, fluoroquinolones should really be earmarked for all those that don’t need alternative therapy choices. An … Read more

Rates of use for three advanced imaging modalities — magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET) scans — increased rapidly between 2000 and 2004. Jean M. Mitchell, PhD, professor of public policy at Georgetown University, examined claims data for physician and outpatient services for people with health insurance coverage from … Read more

In this holiday season, I am pleased to bring you an issue filled with good news. Or, at least, with useful information on diverse topics from compensation for providers to dealing with obesity. Starting at the top, we have a piece about what Brent James, MD, executive director of Intermountain Health Care’s Institute for Health Care … Read more

The greatly anticipated meeting between Medicaid and managed care that’s expected to take place in Florida has been delayed. The program, expected to shift 210,000 Medicaid recipients in Broward and Duval counties into health plans, was to have been launched on July 1. That date has been pushed back to Sept. 1 to give enrollees … Read more

Hill Physicians Medical Group, one of the largest IPAs in the country, has learned to deliver what managed care plans want Frank Diamond Managing Editor Hill Physicians Medical Group is a success story that operates on several levels. Here is an IPA who really seems to “get” managed care. Here are doctors who practice with … Read more

Transparency in contracting is a great thing, but it takes vigilance to keep it from clouding over “What’s in a name? That which we call a rose by any other name would smell as sweet.” Juliet was speaking of Romeo, and expressing a universal truth. Unfortunately, pharmacy benefit management companies (PBMs) would like the world … Read more

The flow of medical information from government health agencies could very well wind up being one of the victims of the anthrax scare. Bad publicity related to the terrorist mailings has led to a major consolidation of communication, legislative, and public affairs offices in the Department of Health and Human Services. The Washington Post reports … Read more

Provenge is just one example of an expensive biotechnology drug whose survival analyses leave much to be desired John Carroll Contributing Editor When Dendreon won a landmark FDA approval for the pioneering therapeutic cancer vaccine Provenge last year, the company managed to stun some longtime industry observers with the price: $93,000 for a full course … Read more

The family of a Texas man who died after drinking antifreeze during a bout with depression has sued NYLCare Health Plans in the first test of a Texas law allowing residents to sue their HMOs. According to a lawyer for the family, NYLCare’s behavioral health carveout contractor, Merit Behavioral Health, told a hospital to discharge … Read more

Washington Watch Health plans and providers got what they wanted from Congress for the new year: passage of the Medicare, Medicaid, and Balanced Budget Refinement Act of 1999. But for Medicare+Choice plans, is it the gift that will keep on giving? Some inside-the-beltway experts say the new law isn’t the panacea it appears to be … Read more

Now that we know there is so much unwarranted deviation in care, payers are promoting comparative effectiveness research and other efforts to help providers embrace the evidence Joseph Burns Contributing Editor Barry Patel, PharmD, is on a mission to improve the delivery of health care, one physician at a time. His company, Total Therapeutic Management, … Read more

Careful interpretation required: Health plans operating in multiple states have a challenge sorting out where the federal law trumps state statutes. With the deadline for complying with the Health Insurance Portability and Accountability Act approaching, it’s important to compare the federal statute to state laws. HIPAA did not set a uniform standard for protection of … Read more

These re-engineered versions of the primary care practice have been discussed since 1967. Has their time come at last? These re-engineered versions of the primary care practice have been discussed since 1967. Has their time come at last? America’s health care crisis is like a Russian Matryoshka doll — open it, and you find its … Read more

While Congress worries about physicians’ salaries and employers bemoan the cost of imaging, it’s orphan drugs that might deserve most attention Earlier this year, NPS Pharmaceuticals surprised nearly everyone who was eagerly waiting for the drug maker to start marketing its recently approved Gattex treatment for short-bowel syndrome, a rare disease in which nutrients are … Read more

A Boston University law professor proposes that Medicare allow health plans to negotiate aggressively with pharmaceutical companies Under discussion this month are proposals to reshape Medicare Part D. At issue is the cost, projected by the Congressional Budget Office (CBO) to be nearly $1 trillion dollars between 2007 and 2017. One proposal is for the … Read more

Everyone seems to agree that one of the main hang-ups during the negotiation of   the Trans-Pacific Partnership (TPP) trade deal was data exclusivity(link is external) for biologics, a key factor in determining when biosimilars can get on the market. But there’s a lot less agreement about what the TPP negotiators have actually agreed to. Full text of … Read more

Philadelphia’s Jefferson Health System has threatened to drop Independence Blue Cross June 1 unless a new contract can be hammered out. Few expect that to happen — Jefferson makes up 20 percent of IBC’s business, while the insurer means a quarter of Jefferson’s revenue. But both sides sent letters to patients and members to frame … Read more

Health-care from the U.S. continues to be exceptional. But several matters Starkly put the American community aside as just much patients cover out of pocket to get healthcare, even should they possess insurancecoverage. “The U.S. enjoys to view on par with additional high tech States,” explained Jonathan Cylus, a former economist in the office of … Read more

Recovering from a kick in the gut from investors in the first quarter of 2008, plans are now looking for ways to adjust to a drop in employer-based coverage   Martin Sipkoff Contributing Editor The industrialist Henry J. Kaiser said that trouble is only opportunity in work clothes. Today’s managed care executives would seem to … Read more

This new class of antibiotic — the macrocycles — has a greater sustained response against re-infection than vancomycin Except for topical medications such as creams, lotions, and eye drops, in general, medications work in the body by being absorbed into the bloodstream and traveling to the needed receptor to perform a task. But the Food … Read more

Once you are wanting to conserve money with limited funds , you devote a whole good deal of time searching for methods to help you help save yourself a dollar. By packaging brownbag lunches into canceling your cable, you are consistently emphasizing how you can invest less. But some times, venturing out of one’s path … Read more

Generic companies aren’t required to update safety labeling In 2013, the FDA proposed changing labeling rules to create “parity” between generic and brand-name drug makers for how they update their labels, exposing generic companies to legal liability if they fail to warn of a drug’s risks. The rule was widely expected to be introduced this … Read more

By JOHN A. MARCILLE Valedictories sound more or less the same. It’s as if there exists some metaphysical blender into which nervous speakers pour the usual suspects — “stand on the edge of a new beginning,” “with the foundation you’ve learned here,” “as I gaze out upon your hopeful faces,” “for everything there is a … Read more

After six years of little change and a lot of subsequent speculation about higher rates to come, HMO premium increases appear to have taken root. For the second straight year, increases in 1999 were in the neighborhood of 8 percent, according to Milliman & Robertson’s latest edition of its HMO Intercompany Rate Survey. The average … Read more

Harvard’s Regina E. Herzlinger says entrepreneurial geniuses will give restless baby boomers what they want: a delivery system in which consumers can choose coverage the same way they shop for cars. Regina E. Herzlinger, Ph.D., is the first holder of the Nancy R. McPherson Professor of Business Administration Chair at the Harvard Business School. An … Read more

Two years ago, ethical issues in alternative medicine seemed hard to recognize. Alternative medicine was just starting to make medical headlines — the first academic centers and fellowships began, elective medical school classes surfaced, outpatient pharmacies stocked up on zinc and echinacea. So two years ago, I used Jonsen, Siegler and Winslade’s Clinical Medical Ethics to outline … Read more

John Marcille Meaningful use. It’s a simple term, but I hear it misused so often. Let’s be clear about it. Meaningful use is not the billions that the federal government is ploughing into health care information technology, nor is it the IT programs themselves. It isn’t the regulations (though in casual conversation, it’s a natural … Read more

The unlikely partnership between the two could portend the beginnings of an industry trend Martin Sipkoff It puts one in mind of what Katherine Hepburn said about Fred Astaire and Ginger Rogers: “She gives him sex appeal, he gives her class.” It’s an odd union, between two kids from opposite sides of the track: Medco, … Read more

Do We Really Have Best Health Care in the World? Experts, including many health plan medical directors, agree: We have a long way to go. Martin Sipkoff Plans Go Directly to Patients, Describing Treatment Options HMOs are developing programs that encourage patients to question their physicians about their treatment options. Doctors are wary. Martin Sipkoff … Read more

With an eye on the demands generated by an aging population, it plans to buy GreatCall, a supplier of health care services for the elderly. Best Buy, the leading consumer electronics business, is the latest retailer to jump into health care, announcing yesterday that it plans to purchase health services provider GreatCall for $800 million. … Read more

As clinicians recognize heart failure’s neurohormonal component, a biologic agent may prove better than the small molecules. Thomas Morrow, MD Linkedin Share ButtonTweet WidgetShare on FacebookGoogle Plus One The United States is in the midst of an epidemic of heart failure arising from the convergence of factors that include the aging population, advanced cardiac salvaging … Read more

Colorectal cancer screening for white, black, and Asian Americans age 50 and over has improved says the Agency for Healthcare Research and Quality. The same can’t be said for Hispanics, whose screening rates barely improved, or for American Indians, whose screening rates fell…. Members in integrated health systems report higher rates of satisfaction than members … Read more

When magazines like this one recommend some action to physicians as “worth the time it takes,” do you sometimes wonder where the time is supposed to come from? This article may help. Time is the currency of managed care. Unfortunately, patients feel they need 30-minute office visits, while HMOs believe they only require 15. Doctors … Read more

By Michael D. Dalzell Senior Editor Drug-related illnesses and complications cost the health care system hundreds of billions of dollars each year. They are a red flag for poor quality of care, and perhaps more important, they are often avoidable. Consultant pharmacists have long said the value of their work can be measured in prevention … Read more

Has reported better-than-expected preliminary benefits in the provider’s chronic kidney disorder study has been conducted on the island of Bonaire. Preliminary investigation of this preliminary study outcome indicates, at a 95 per cent confidence level, which three out of 4 users can reasonably anticipate a ten% growth in filtration speed. The data, examined by an … Read more

January 2016 February 2016 March 2016 April 2016 May 2016 June 2016 July 2016 August 2016 September 2016 October 2016 November 2016   2010 2011 2012 2013 2014 2015 2016 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 1996 1997 1998 1999 Paul LendnerPaul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin … Read more

Harris Methodist Health Plan has submitted a revised physician-compensation plan with the Texas Department of Insurance that eliminates controversial fines on physicians who surpass their prescription drug budgets. Harris Methodist, the largest HMO in northern Texas with 279,000 members, also will pay an undisclosed amount to doctors who remitted the fines. State regulators and a … Read more

Focus medication-assisted treatment of opioid addiction on people who have been incarcerated. A program with a 12% success rate and (talk about perverse incentives!) the requirement that patients break the law to get treatment? That sounds like the kind of innovation payers should avoid, not embrace. But what if it also takes a small bite … Read more

Mergers and acquisitions continue to be one of the hottest topics in managed care, as health plans increasingly find themselves in a position where they need to grow or else, according to A.M. Best, the rating company. “A.M. Best expects growth of stockholders’ equity in 2004 to be augmented by significant increases in goodwill because … Read more

We Yanks might learn a thing or two about making decisive, countrywide health care decisions from our Canadian neighbors Lorraine Fernandes, RHIA, RHIT We in the United States are facing a crisis with the inequality and high cost of our health care services. We have a fragmented health care delivery system that functions with discrete … Read more

In Florida, one physician group believes trading away a measure of financial independence to a physician practice management company has actually given it more clout where it counts. BY JEAN LAWRENCE Contributing Editor Taking back the power?” muses neurologist Steven R. Cohen, M.D., Ph.D., president of the St. Petersburg/Suncoast Medical Group. “I prefer the word … Read more

Whatever happens to the ACA, says this upbeat doctor-policymaker-entrepreneur, it was only the beginning of health care’s transformation. But will this version of better health care mean pink slips? New health care ventures to spend money on? That would seem the last thing the U.S. economy needs. We’re far and away the world’s champion health … Read more

International health financing has grown in the past several decades. This was combined with a proliferation in the range of international health stars and actors. This paper clarifies the nation of international finance, taking into consideration private and government sources of fund, and discusses and raises a range of policy problems associated with global health … Read more

All 50 states and the District of Columbia had begun enrolling youngsters in the Children’s Health Insurance Programs (CHIP) by last December, swelling the ranks of those insured under the program to 2.7 million…. A study funded by the Centers for Disease Control and Prevention says that only 25 percent of adults reported being encouraged … Read more

Anticoagulation pharmacist at St. Mary-Corwin Medical Center, Pueblo, Colo. Clinical pharmacist at Colorado Mental Health Institute at Pueblo. At the time the article was written, she was director of pharmacy services for St. Mary-Corwin MCOs should consider adding pharmacist-managed anticoagulation clinics to the benefits of their members because both patients and physicians show a high … Read more

The old TennCare program had many flaws and detractors. Its near collapse led to a more realistic approach to providing coverage to the uninsured in Tennessee. TennCare is one of the most controversial Medicaid experiments in the recent history of state-level health care reform. Launched in 1994, this bold and ambitious health insurance initiative was … Read more

As different sectors of the drug industry battle, pharmacists may follow the easier — and more expensive — path John Carroll Back in mid-May, the governor of Virginia signed off on a law that sets up some ground rules on when and how pharmacists will be allowed to replace a branded biologic with a biosimilar, … Read more

Integrated health care systems are seizing the momentum in care coordination from HMOs, says the author of the well-read Internet Healthcare Blog. Health care researcher, consultant, and blogger Matthew Holt says his role “is to support those in the industry trying to look to the near horizon or to those outside health care who want … Read more

Next year is a big year for Medicare Advantage plans. In 2015, they will not receive bonuses unless they have a 4-star rating or above. Many health plans are feeling under pressure right now, and may even feel a little disgruntled, as their businesses could really take a hit next year if they fall even … Read more

Fewer than 15 million Americans buy their own health insurance. That’s only 5 percent of the population, but states continue to struggle with issues of access and affordability in the individual market. In contrast to group insurance, the individual market is a high-risk proposition because a disproportionate number of these individuals tend to buy insurance … Read more

Notwithstanding a black box warning from the FDA, ongoing research demonstrates the efficacy of treating adolescents and children with antidepressants Martin Sipkoff Perhaps no issue in mental health treatment is more emotionally laden and controversial than whether adolescents and children should be treated with antidepressants. “It has been an issue which has led to debate … Read more

Medicare’s Value-Based Purchasing Program Makes hospitals Based on worth of maintenance given. Multilevel random coefficient models estimated significance and mean of TPS differences from financial year 2015 and FY 20-16, by hospital type. In general mean TPS for 2985 hospitals dropped from 41.65 into 40.25. POSH and Kaiser Hospitals had substantially higher TPS at FY … Read more

Medicare+Choice Reform: Hope, but No Quick Action Expected There have been small accomplishments, and wheels have been churning for more forceful action — that is, they were until Sept. 11. Michael Levin-Epstein Indirect Costs: Asking plans to keep employees on the job Employers in revolt against fast-rising premiums could ask HMOs to pay more attention … Read more

In spite of the fact that it’s trivial to state the collection of earthquakes which struck Nepal from Spring 2015 will dramatically alter the united states, what this shift will contain still remains undetermined. As numerous earthquake sufferers learn how to create perform in houses that are broken, stalls, or even corrugated tin arrangements, post-earthquake … Read more

Health plans can work directly with customers to design RA management plans that address indirect but substantial costs Employers and managed care organizations alike experience tremendous costs because of the number of workers with chronic and painful disabling conditions. By some estimates, employees with chronic diseases account for nearly two thirds of an employer’s total … Read more

Most specialties saw modest increases in compensation in 2003, according to the American Medical Group Association’s 2004 Medical Group Compensation & Financial Survey. Cardiologists, dermatologists, gastroenterologists, and pathologists in particular, enjoyed the largest increases in compensation. Median salary for 2002 was $217,652. In 2003, the median salary reported was $237,101. “Last year, we actually saw … Read more

Surveys say a lot about quality and are continuously conducted by HMOs and accrediting bodies. The authors suggest medical groups follow suit. Roger Bolus, Ph.D. Jennifer Pitts, Ph.D. “Why measure satisfaction when the health plans we contract with already do it?” “How can we conduct a satisfaction survey that won’t disrupt office work flow?” “How … Read more

The dollar amounts have changed and so have the cities, but California is still the golden state to be a pharmacist. The federal Bureau of Labor Statics (BLS) provides a list of the top four employment and wage figures for pharmacists, calculated from employers in all industry sectors in metropolitan and nonmetropolitan areas in every … Read more

The USPSTF Advocated This clinicians provide PrEP with effective antiretroviral therapy to people that face a greater chance of having HIV. The USPSTF also published a split up recommendation announcement along with evidence report. In its recommendation announcement, the USPSTF explains men at elevated risk of HIV As sexually active homosexual or homosexual men, heterosexual … Read more

Health Reform and the Use of Financial Incentives in Wellness Programs Paul Terry PhD The Affordable Care Act codified the worksite wellness exemption to the federal medical underwriting provisions in the group health plan market. This means companies are allowed to use an “outcomes-based” incentive model that provides financial rewards for those who satisfy a … Read more

Hospitals now face stiff penalties and some health plans see this as a way to attain a long-sought goal John Carroll A little more than two years ago, Victor Caraballo, MD, the senior medical director at Independence Blue Cross in Philadelphia, set out to hit the brakes on the flow of unnecessary readmissions to area … Read more

A noble goal, though Medicare Advantage plans may suffer in the course of determining just what scans are appropriate Lola Butcher MANAGED CARE July 2006. ©MediMedia USA A noble goal, though Medicare Advantage plans may suffer in the course of determining just what scans are appropriate Lola Butcher The launch of a new registry that will significantly … Read more

TOMORROW’S MEDICINE Enhanced management continues due to a greater understanding of the intricate glucose balance and the shortfalls of existing medications. Thomas Morrow, MD The United States is facing an unprecedented challenge from type 2 diabetes, a disease characterized by a combination of insulin resistance and progressive pancreatic beta cell dysfunction. The glucose balance is … Read more

Up and Up They Go. Can Drug Prices Be Brought Down to Earth in 2019? It’s no secret that list prices for prescription drugs are increasing. Every year, pharmaceutical companies are raising their prices whether it is for brand drugs or generics. Novel therapies, often for rare diseases, are coming on the market priced at … Read more

A collection of articles from our archives. Most recent first. See also: Managed Care’s popular DMFORUM — a lively ongoing e-mail discussion group. Follow this link for more information and a sign-up form. 2011 Can Self-Management Programs Ease Chronic Conditions? In-person and Internet group programs such as the Stanford model are now available to millions, … Read more

Update your scorecards: Indiana-based Anthem is buying Blue Cross-Blue Shield of Maine, Altius took Intergroup of Utah off of Foundation’s hands, and ConnectiCare is buying that state’s chunk of Kaiser Permanente’s Northeast empire…. Health Plan of Nevada wants to cut costs for two antidepressants and a cholesterol reducer by cutting pills. HPN asked members to … Read more

MANAGED CARE OUTLOOK Effect of biologics will be felt worldwide by 2017 Biologics will be about 20% of the world pharmaceutical market in three years, according to a study by the IMS Institute for Healthcare Informatics, part of IMS Health. That amounts to about $220 billion. “Development and production of biologics both branded and generic … Read more

More than two thirds of primary care physicians in the United States use electronic medical records, a substantial increase from 2009, says a survey in the December Health Affairs. “Although the United States and Canada still lag behind countries with near-universal adoption, the spread has been rapid in both countries, with a 50 percent increase … Read more

HOPE and CURE trials find that significant reductions in major cardiovascular events are associated with ramipril and clopidogrel therapies. Walter Alexander Results from large-scale clinical trials of two agents prescribed for patients at high risk of cardiovascular events suggest benefits with broad implications for managed care. Wide use of either drug, according to experts at … Read more

If the next pandemic is anything like the 1918 outbreak, some small regional health plans might see their membership decimated, or worse Jack McCain Contributing Editor With worries about an avian influenza pandemic running rampant, it is reasonable to wonder about how such an event would affect the financial health of insurers in the United … Read more

Getting frugal does not only mean saving cash –this entails spending your cash sensibly. This means a few matters could possibly be economical today, but cost you in the long term, while other times it is logical to pay more today for a better, more longer-lasting experience. Let us have a good look at if … Read more

For the longest time, payers have been talking about ways to control drug spending in medical benefits plans. Now, there are signs that many are starting to become more assertive. It’s rare for commercial payers to have drug formularies for medical benefits, but a recent survey found that 92% of payers do use product preferencing … Read more

Initial 2010 HMO premium rates will increase by 11.8 percent — consistent with last year’s projected rate increases and down from 13.2 percent in 2008, according to Hewitt Associates, a human resources consulting company. This increase is fueling greater interest in self-insured plans and other strategies to hold costs down. Over the past few years, … Read more

The following paragraph is from the American College of Physicians Ethics Manual, 6th Edition: “Physicians have a responsibility to practice effective and efficient health care and to use health care resources responsibly. Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources … Read more

In 1995, Dr. Steven Rosenberg published an article in the New England Journal of Medicine (NEJM) that fueled the start of an industry. In a randomized, controlled trial, he showed that an investing in proactive disease management (DM) activities could decrease the cost and improve the quality of life for patients with congestive heart failure. … Read more

The emerging specialty of inpatient medicine, practiced by “hospitalists” or “designated admitting physicians,” could shake up primary care as well as hospital and HMO management, an article in the Aug. 15 New England Journal of Medicine suggests. Physicians Robert M. Wachter and Lee Goldman of the University of California at San Francisco point out that … Read more

Boutique medicine is dysfunctional, but probably not unethical — so long as the lucky patients understand that they’re not necessarily paying for better care. Boutique medicine is dysfunctional, but probably not unethical — so long as the lucky patients understand that they’re not necessarily paying for better care. I want credit for the saintly discipline … Read more

References to maximum allowable prices in contracts between plans and PBMs need to be scrutinized, since things are not always what they seem For most of the world, the letters MAC conjure up a Big Mac — the inviting super-sized hamburger that people love but enjoy at their peril. But for health plans providing prescription … Read more

Even the least lethal form of breast cancer can reappear and turn deadly years after a woman’s last treatment, according to a study by Kaiser Permanente. “Impact of Breast Cancer Subtypes and Treatment on Survival: An Analysis Spanning Two Decades,” says that women with luminal A tumors are still at risk for death more than … Read more

In the managed care industry, it’s not uncommon to think of providers as resistant to change, protective of their historic turf, and unappreciative of the real contributions that health plans, PBMs, and DM companies make toward patient care. These perceptions are often correct, though not all the time and not everywhere. After all, it’s not … Read more

Expanded blood testing can reveal much about individuals’ health risks, but how should health plans decide on coverage? Cardiologist George Rodgers, MD, still remembers the fiftyish woman he examined years ago after she reported chest discomfort. “As I was leaning in to listen to her heart, I encountered a peach-sized tumor in her breast,” he … Read more

History has vindicated Paul Ellwood’s prediction of a price-competitive health care market. Is he right again in saying the current trend away from integration will be reversed? Paul Ellwood Jr., M.D., comes closer than anyone else to being the father of modern managed care. He coined the term HMO, and he–along with Stanford University economist … Read more

Friends and foes of “any-willing-provider” legislation don’t line up as predictably as they once did. And even in the states that have enacted such laws applying to physicians, AWP is turning out to be a less ferocious beast than its backers had hoped. “We’re not in favor of ‘any willing provider’ legislation because it is … Read more

By March 2, hospitals and long-term care organizations must inform the Joint Commission which clinical outcomes they will measure. The plan telegraphs a change in accreditation standards that few care to predict.   At first blush, it seems so simple. Post-surgical infections, high Cesarean-section rates, deaths following cardiovascular surgery: These are negatives for health care … Read more

MANAGED CARE June 1996. ©1996 Stezzi Communications For-profit, investor-owned health plans are setting the growth pace these days, and some nonprofit plans are switching to for-profit status to keep up with the competition. But are the two kinds of plans really so different? Paul Wynn Associate Editor Tune your dial to National Public Radio, flip to Harper’s … Read more

PacifiCare says it isn’t necessarily for sale, but won’t rule one out, either, as it examines “value-increasing strategies.” PacifiCare’s soul-searching, prompted by a 43-percent decline in its stock price this year, officially began on a November day when it shook up management and formed an executive committee to sift the company’s options. PacifiCare President Jeffrey … Read more

Patient satisfaction remains an important characteristic of a health plan, particularly at open enrollment time. WilsonRx’s annual survey tells the tale. …Tricare. Tricare, the health plan run by the U.S. Department of Defense, is the best health care insurer in the nation, followed closely by Kaiser Permanente, CareFirst Blue Cross Blue Shield, AARP, and Blue Cross … Read more

Americans are going to emergency departments for traumatic brain injuries in record numbers. What’s behind the increase? What are obstacles to care? The CDC, the World Health Organization, and a string of prominent U.S. medical organizations have repeatedly and unequivocally declared traumatic brain injury (TBI) a major public health problem. Yet that’s where certainty about … Read more

The feds will help you launch a health plan for the elderly, but just what does it take to get something like this operating in so short a time? Frank Diamond Managing Editor Managed Medicare is going to work this time, even if it means that CMS has to drag health plans to the starting … Read more

Physicians have to accept the programs for them to work. But most doctors need to be convinced that they’re worthwhile. When Ellen Hughes, M.D., enrolled one of her patients in a program to help people with heart disease learn how to take better care of themselves, it was a well thought-out move. The patient was … Read more

It doesn’t take much to help reduce the stress a patient experiences in a clinical setting. Be mindful of surroundings. PRACTICE ENVIRONMENT Lively, colorful chairs lend cheer to this waiting area in the imaging center at Advocate Christ Medical Center in Oak Lawn, Ill. Warm overhead paint complements cool purple-and-blue carpet to balance the emotional … Read more

The individual intestine commensal microbiota creates a intricate people of germs that live by keeping up a symbiotic partnership with the bunch. Between the metabolic benefits that it attracts, creation of elastic immune system and upkeep of its own homeostasis are acts that play a significant duty. This informative article discusses the key aspects of … Read more

PRACTICE GUIDELINES Like an assembly line grinding to a halt, the Agency for Health Care Policy and Research has manufactured its last set of regular clinical practice guidelines. The government-funded agency’s future role in the guidelines-making arena will be to supply the scientific resources to help health plans, professional medical societies and other groups create … Read more

Into Senator Bob Packwood. Back in 1981he had been appointed by President Reagan as Deputy Assistant to the President for Intergovernmental Affairs, together with responsibility for liaison with governors, state legislators, mayors, along with other local and state officials. Back in 1983he was appointed Deputy Assistant Secretary for Import Administration at the Commerce Department, together … Read more

Speaking of a bill of rights, millions of beneficiaries in federal health care programs recently received one, courtesy of an executive order signed by President Clinton. The president’s order establishes a set of minimum consumer protection standards, including direct access to medical specialists for patients with serious conditions; right of appeal to an outside panel … Read more

Record-High Number of Cases in France, Italy, Greece, Other Locations Measles cases throughout Europe are at a record-high level, and U.S. travelers should make sure they are up to date with measles immunization, and other recommended vaccines, say the Centers for Disease Control and Prevention. As of March 28, 2019, the World Health Organization European Region reported … Read more

BlueCross BlueShield of North Carolina’s vigorous patient-centered medical home may be an example to other plans and providers Frank Diamond Managing Editor The brave new world of provider-payer cooperation requires an approach that’s somewhat at odds with traditional managed care, says Don W. Bradley, MD, senior vice president for health care and chief medical officer … Read more

CMS proposed new protections for Medicare beneficiaries in Medicare Advantage and prescription drug plans by providing more regulation on door-to-door marketing and cold-calling, as well as new proposed requirements pertaining to broker/agent commissions. The proposal goes beyond what the health care insurance industry recently endorsed as necessary regulatory changes to the program for development. “This … Read more

LOOKING FORWARD For other articles in the series, see listing at end Steve Wetzell Buyers of health care are looking at risk adjustment to discourage parsimonious care. They’re also hoping to transfer power and responsibility to workers. Historically, businesses that provide health coverage have acted independently, doing their best to balance the pressure points: network … Read more

Imagine an America where few businesses purchase health care for employees. Should that come about, the individual market will have new products ready. If employer-sponsored health benefits go the way of the Model T, the big managed care companies in the Detroit market intend to be ready. In June, Health Alliance Plan made its first … Read more

Paying for medical group practice redesign can significantly enhance the quality of care for chronically ill patients, and perhaps lower long-term costs Health plan investment in medical group practice redesign to improve management of chronically ill patients results in significant improvement in the quality of care — notwithstanding expense and equity sweat. That is the … Read more

MANAGED CARE July 2010. ©MediMedia USA Patients who use blood pressure monitors at home and use Web reporting tools that connect them to clinicians appear to significantly improve their ability to manage their hypertension, says research from Kaiser Permanente Colorado. The study involved 348 patients with uncontrolled blood pressure who were randomly categorized into two groups: usual … Read more

When Congress returns this month, the topic of patient rights will be simmering on the front burner. Before adjourning for its summer recess, the House passed the GOP-backed Patient Protection Act on virtually a straight party-line vote, 216­210. President Clinton vowed to veto the Republican measure in its current form. Unable to reach agreement on … Read more

The Institute for Medical and Fiscal Inspection now published a Final Proof Report along with Report-at-a-Glance analyzing the relative clinical efficacy and financial worthiness of three serious treatments for migraine: lasmiditan, rimegepant (Biohaven), along with ubrogepant. “For patients that cannot choose triptans or who really don’t become sufficient advantage from those less expensive choices, those … Read more

Adjusted fourth-quarter 1998 earnings for publicly-held HMOs were up 21.1 percent from the same period in 1997, according to a study by HealthCare Markets Group. The figure excludes Oxford Health Plans, whose legendary dismal performance in the last quarter of ’97 skews year-to-year comparisons. Among the big winners in 1998: PacifiCare, with adjusted earnings up … Read more

Found mutations in 1 2 genes considered to be chiefly responsible for the onset of MS in families with a number of members identified as having this disorder. “These enzymes are similar to a light house illuminating at which the origin of MS isalso,” said lead author Carles Vilariño-Güell, assistant professor at the UBC faculty … Read more

Attempts to replace radiology benefit managers with a more doctor-friendly system show success Joseph Burns Contributing Editor Proponents of clinical decision support (CDS) systems believe these tools are capable of putting utilization reviewers out of business. In the first skirmish in what could be a long war, physicians in Minnesota have developed a CDS system … Read more

Meaningful Use: Tasty Carrot or Big, Brutal Stick? The stimulus bill’s $27 billion for health information technology will go to providers, but health plans will experience other financial and operational benefits. HIT Decisions Lie on the Horizon, But Savings Remain Elusive How electronic health records, in their many manifestations, will transform health care should be … Read more

Disorders characterized by progressive muscular weakness as well as in a number of instances coronary and respiratory muscle engagement. Historically, these illnesses are deemed incurable with tomb prognoses. The enzymes responsible for many muscle dystrophies are understood, and ancient identification is attainable with appropriate clinical comprehension along with complex genetic testing. This report reviews recent … Read more

When it comes to pay-for-performance programs, physicians view them with “deep suspicion,” says Bill Steiger, editor of the Physician Executive, the journal of the American College of Physician Executives. He bases this assertion on results of a recent national poll undertaken by the association. The survey showed that physicians “are not convinced the payment systems will … Read more

MANAGED CARE October 2001. ©MediMedia USA In past years, the National Committee for Quality Assurance has used the annual release of its “State of Managed Care Quality” report to goad health plans into better HEDIS performance. Plans that do well are stroked; minimal improvement is called not good enough; and those that do not participate … Read more

Realizing they’d better do something to charm shaky voters before election time, members of the House of Representatives last month passed an amendment-laden version of the Kennedy-Kassebaum health insurance reform bill. At its core, the bill would prohibit insurance companies from denying individual policies to people who had carried job-related insurance for 18 months, dropping … Read more

We reported last month on the seriousness of the problem of antibiotic-resistant bacteria (http://bit.ly/1hMgxTa). That problem affects all ages. Most children (77%) are resistant to three or more antibiotics usually used for extended-spectrum beta-lactamose (ESBL)-producing enterobacteriaceae infections. This, according to a study in the Journal of the Pediatric Infectious Diseases Society. Researchers conducted a case-case-control … Read more

Pilot vaccination program will be executed in three African countries The world’s first malaria vaccine will be rolled out in pilot projects in sub-Saharan Africa, the World Health Organization (WHO) has announced. Funding is now secured for the initial phase of the program, and vaccinations are due to begin in 2018. The vaccine, known as … Read more

True or false: Nearly half of all personal bankruptcies are caused by expensive illnesses. Answer: Depends on whom you ask. A much-reported study by David Himmelstein, MD, of Harvard Medical School that says that medical bills are the cause, at least in part, of 46 percent of bankruptcies, is being challenged. A Health Affairs article … Read more

I’m really excited about this issue. Major change is afoot in the managed care industry, and we are writing history’s first draft. Take our cover story. For many years we’ve been reporting on pay-for-performance programs, and I always felt that, as well-intentioned as proponents of these efforts were, something was amiss. Does it really matter … Read more

Surveys say a lot about quality and are continuously conducted by HMOs and accrediting bodies. The authors suggest medical groups follow suit.   “Why measure satisfaction when the health plans we contract with already do it?” “How can we conduct a satisfaction survey that won’t disrupt office work flow?” “How do we translate satisfaction findings … Read more

Paperwork-hassled physicians might be thankful if a plan by Humana, Oxford, and United HealthCare is the start of a trend: a single credentialing application honored by all three companies.The three agreed to use a universal application, thus avoiding duplication for physicians who contract with more than one. All three outsource credentialing to the same company, … Read more

By Gary Scott Davis, J.D. The federal government’s recent blessing of a new variety of managed care delivery vehicle, the provider-sponsored organization, offers an attractive opportunity to physicians, hospitals and other providers. If they respond, the addition of PSOs to the market could change–presumably for the better–the way health plans, providers and patients interact with … Read more

Move comes amid national drug-pricing controversy Last week, Pfizer increased the list prices of its medications in the United States by an average of 8.8%, according to an article in STAT News. This is the second time this year that the company has boosted prices for its prescription drugs. On January 1, Pfizer’s prices rose … Read more

HEALTH PLAN 2009 As the Managed Care editorial team gathered the names of policy experts to approach for our five-year look forward, we were struck by how quickly we could fill a page with candidates who would have a valuable perspective. After weeks of whittling and editing, we are proud to present these essays from … Read more

What happens if one physician parks for free in a hospital parking lot to attend a committee meeting and another physician parks for free to make rounds, see patients, and earn a significant amount of money? Does the fact that there is a financial benefit for the physician in one situation, but not the other, … Read more

Nearly 52 percent of doctors are familiar with the term “accountable care organization” and half of those say that their practice is already participating in one or expects to, says a working paper by UnitedHealth Group. “[I]nterest in participating was notably higher among PCPs — 55 percent of PCPs familiar with the term were pursuing … Read more

5 Product Engineering Methods To Use in Health Care Management These tools, often adopted by other industries, can help insurers improve health care delivery Preetinder S. Gill inShare Tweet Widget (link is external) Also available in PDF Preetinder S. Gill A healthy workforce is critical to the success of an organization or a society. Properly … Read more

The insurer’s CEO explains the company’s approach to growth, how a team-based system nurtures better care, and why he thinks Medicare for all might not work. We interviewed Marc Harrison, MD, shortly after he became CEO and president of Intermountain Healthcare in Salt Lake City. Now, three years later, we thought it would be a … Read more

Back in mid-May, a pair of congressmen from Texas representing both sides of the aisle put forward a new piece of old legislation. Their Health Care Price Transparency Promotion Act of 2012 directs states to mandate hospitals to shine a light on their price list for services. The Republican, Michael Burgess, and his Democratic counterpart, … Read more

By David L. Coleman, J.D. Contributing Editor In the court of public opinion, these are not the happiest times for managed care companies. The news media routinely trot out horror stories about HMOs denying care to patients, resulting in serious injury or death. Election ballot initiatives pop up that would ban financial incentives such as … Read more

Many experts predict that there will be a dearth of primary care doctors, but others are not so worried In response to warnings of a significant physician shortage, allopathic medical schools are expanding enrollments by more than 20 percent, and osteopathic schools are growing even faster. However, a cap on graduate medical education funding and … Read more

We’ve known Michael O’Donnell, the publisher and editor in chief of the American Journal of Health Promotion, for 30 years. He is not prone to hyperbole. So he got our attention when he recently wrote that he had just published “the most extensive and well-conceived review conducted to date” on the financial impact of workplace … Read more

LORBRENA is currently suggested for adults who have metastatic NSCLC whose microbes are ALK-positive as discovered through an appropriate test. The FDA activity additionally extends the 2018 hastened approval to full approval. The application form had been approved under the FDA’s real time Oncology Review pilot app. “For over ten years, Pfizer was a pioneer … Read more

Developers make progress with genetic markers aimed at improving drug response Developers make progress with genetic markers aimed at improving drug response Medication therapy for mental illnesses can be a shot in the dark. Antidepressant and antipsychotic medications are characterized by partial response, nonresponse, and resistance to treatment. That results in switching, combination therapy, nonadherence, … Read more

In one of the most dramatic comebacks in health care, 80% of hospitals and over 50% of doctors’ offices will receive incentive payments this year for installing electronic health record systems that meet government meaningful use standards, according to the Department of Health and Human Services. It was only a few months ago that the … Read more

On the theory that capitating primary care can lead to unnecessary referrals, a group of California physicians has decided to pay fees to primary care and to capitate specialists. It seems to work. Pacific Communities Management Services Organization Harbor City, Calif. Capitation is often characterized as a means of cutting physicians’ compensation, but there’s a … Read more

This is barely a blip on the screen and yet, just the fact that it’s being discussed in some places points to dissatisfaction with HMOs’ programs. By Frank Diamond Senior Editor Even the slightest tremor in disease management can now move millions of health care dollars. And here’s one just tickling the seismograph: faint indications … Read more

From his vantage point at the National Conference of State Legislatures, Richard Cauchi counts 900 state laws that mold the way business is done by health plans coast to coast. It started about 10 years ago, as managed care emerged as a leader in the delivery of health care — and a lightning rod for … Read more

The push to integrate health care services and financing may portend a move away from behavioral health carve-outs Senior Contributing Editor Managed care sure bent the cost curve, all right — at least, in the area of behavioral health care. From 1986 to 2005, the last year for which comparable data are available, the share … Read more

Only about 35 percent of girls get the full three doses of the vaccine for the human papillomavirus, which causes most cervical cancers The evidence is not pretty, and Chuck McKinzie, MD, knows it well. After 28 years as an Ob-Gyn in rural Minnesota, McKinzie has seen too many cases of HPV infection. If teenage … Read more

It’s a problem, all right. Patients aren’t just complaining any more. As forgotten players in what all too often seems to be a tug of war in many directions, patients — the ultimate consumers of health care, are making their presence felt. A few years ago they might simply have groused about being denied a … Read more

First once-daily oral JAK inhibitor treatment for RA indication The FDA has given the green light to extended-release tofacitinib citrate tablets (Xeljanz XR, Pfizer) for the once-daily treatment of moderate-to-severe rheumatoid arthritis (RA) in patients who have had an inadequate response to or are intolerant of methotrexate. Extended-release tofacitinib is the first and only once-daily … Read more

By Jeffrey J. Denning Contributing Editor Managed care organizations are now part of the fabric of every metropolitan area and many less populous areas. No matter where doctors reside, I hear them wrestling with concepts and practices such as capitation, utilization review and credentialing. Some are trying to adapt their practices and their thinking as … Read more

Department Seats, managing Spouses, medical Managers, chiefs of All Staff–they are all frustrated. Like a practicing doctor with experience in a number of leadership roles, I understand how they believe: ” They do not remember saying for their youth friends,”that I wish to be Vice President of Medical Affairs once I develop ” Rather, they … Read more

Advocates say it will transform health care; detractors warn against overestimating its potential Neil Versel Google is getting into health care with a personal health record being introduced in cooperation with the Cleveland Clinic, and may have other products in mind. Microsoft, already a strong player in the sector, got a jump on Google a … Read more

For physicians, reclaiming a measure of clinical autonomy can be a matter of health itself. But alas, there’s no one blueprint to follow. Burnout can be subtle,” says John Henry Pfifferling, Ph.D. “It is a slow, aggregating erosion of energy. It’s not something that happens overnight. You no longer look forward to working. You no … Read more

September 11 underscored the prevalence of post-traumatic stress disorder. Screening could ultimately reduce utilization. But who should be screened? By coincidence, the anniversary of September 11 passed as Congress began debate on an updated mental health parity act. This juxtaposition, though, may help the bill’s chances of passage, considering that one lasting effect of the … Read more

The Medical Directors Forum offers an opportunity for discussions with peers and a resource for information about guidelines Find the forum at: MedicalDirectorsForum.com Think of the Medical Directors Forum as a gathering of baseball players from opposing teams who want to discuss the art of hitting. They are not revealing what strategies their teams might use … Read more

E-Health’s Greener Pastures The trend is unmistakable: Physician executives are leaving their high-pressure, high-paying jobs at health plans, and are starting from scratch in the nascent e-health industry. The lure? A chance to leave their mark on something. Health Plans Demand Proof That DM Saves Them Money Can disease management vendors really show a strong … Read more

Whatever happens to the ACA, says this upbeat doctor-policymaker-entrepreneur, it was only the beginning of health care’s transformation. But will this version of better health care mean pink slips? New health care ventures to spend money on? That would seem the last thing the U.S. economy needs. We’re far and away the world’s champion health … Read more

The Health Care Financing Administration has defined provider-sponsored organizations for purposes of Medicare, clearing the way for PSOs to offer themselves as an option under Medicare+Choice beginning Jan. 1. The Federal Register published HCFA’s interim final rule April 14. HCFA defines a PSO as an entity operated by a health care provider or group of … Read more

With Congress debating renewal of the Mental Health Parity Act, it can be argued that Sept. 11 added urgency to expanding access to behavioral services. Sidebar: Counseling in the aftermath of terror As a nation, we are dealing with enormous emotional trauma from the events of Sept. 11, 2001, and anxiety over what might happen next. … Read more

On Aug. 21, President Clinton signed the Health Insurance Portability and Accountability Act of 1996 into law. HIPA is extremely significant for physicians and managed care organizations. I’m not referring to the portions of HIPA that gained the most press coverage–namely, the creation of an entitlement to (and mechanisms for) more affordable and portable health … Read more

Great Britain has decided to incorporate its own share of global Aviation and shipping emissions in its own Carbon Budget — an equally significant part the administration’s decarbonisation efforts that’ll enable for all these emissions to be accounted for always. Consistent with the recommendation against the individual Climate-change Committeethis sixth Carbon Budget restricts how many … Read more

Patients who have multiple comorbidities and who take multiple medications may benefit most from a secure e-mail messaging system, according to a study conducted by the Kaiser Family Foundation that appeared in the American Journal of Managed Care. Members of Kaiser Permanente’s northwest region were given access to parts of their individual health records through a … Read more

As of December 2009, there were 10.9 million individuals enrolled in Medicare Advantage (MA) plans. That’s more than a million member increase from 2008. And although a million member bump and an annual growth rate of 10.4 percent are respectable, according to A.M. Best, the credit rating organization, it’s lower than the growth rate of … Read more

Jean Lawrence MANAGED CARE July 1997. ©1997 Stezzi Communications Washington Initiatives When Senate Majority Leader Trent Lott calls the president of the United States “a spoiled brat,” you can pretty much assume the subject is the budget. Nothing ignites invective so much as weighty financial matters of state — unless maybe it’s Medicare, itself a big budgetary … Read more

We want to hear from medical directors about how they approach one of the most vexing and chronic problems in health care Frank Diamond Managing Editor Do you, Mr. Medical Director, have a definitive solution to the growing problem of overutilization in emergency rooms? If you do, then we’d like to hear from you via … Read more

Resources Disease Management Forum Call for Manuscripts Subscribe Rate Card Production Details for Ads and Inserts Classifieds Recent blog posts Disruptive Innovation Could Up-End an Innovative Industry Is There an Advocate in the House? Health Reform and the Use of Financial Incentives in Wellness Programs An Easy and Profitable Way to Turbocharge Disease Management? Welcome … Read more

The United States’ health care system needs consumer and market controls to succeed, but it can’t rely on only those two factors MANAGED CARE June 2007. ©MediMedia USA The United States’ health care system needs consumer and market controls to succeed, but it can’t rely on only those two factors Jonathan Weiner wants you to know that, … Read more

Patients with acute myelogenous leukemia (AML) whose disease had relapsed or was resistant to chemotherapy and those who were unable to tolerate chemotherapy have shown clinical responses to venetoclax (Venclexta, AbbVie/Genentech), with complete remissions in some, according to new phase 2 data published in Cancer Discovery. Venetoclax is a small-molecule B-cell lymphoma 2 (BCL-2) homology 3 … Read more

There’s a lot of support and momentum behind telemedicine, as the cover story in Managed Care’s July issue well documented. Videoconferencing, text messaging, and email mean that the treatment option might soon become common practice. Maybe. There are still significant roadblocks, as Kaiser Health News pointed out last month. For instance, the population that’s most … Read more

Host Dan Gorenstein was the senior health care reporter on the Marketplace radio program So many podcasts, so little time—and only two ears to listen with. But Dan Gorenstein’s new Tradeoffs podcast belongs in your queue. It launched late last year and is picking up steam. Gorenstein, his two co-hosts, Sayeh Nikpay and Anupam Jena, … Read more

The recent Fifth Circuit Court decision on Texas’s statute allowing patients to sue HMOs for denial of physician-recommended care is helping to clarify where state and federal interests in patient rights lie — and what Congress could do to spell out those interests. However, health-industry insiders question whether the ruling — or anything else — … Read more

Sue McQuillian, FSA Consulting Actuary, Milliman USA Full text of this article is available in PDF Introduction Recent regulatory pressures and certification requirements have heightened the need for payer organizations to abide by specific standards regarding medical management operations. Payer organizations that are making medical-necessity determinations regarding reimbursement for health care services, as well as … Read more

Employers Expect Moderate Cost Increases But Keep Wary Eye on Specialty Pharmacy Expect overall health benefit cost increases at large employers next year to come in at a moderate 6%, but most of that will be because of specialty pharmacy costs, which are expected to skyrocket, according to a survey by the National Business Group … Read more

‘Take My Word for It’: The Enduring Dispute Over Measuring DM’s Economic Value While DM is now mainstream, it can still be difficult to judge a program’s worth. Health plans faced with renewing DM contracts have a lot to think about. Maureen Glabman A Conversation with Paul Fronstin, PhD: Current Crop of Consumer-Directed Plans More … Read more

Also available in PDF New Mexico has just granted medication-prescribing authority to psychologists — a development with broad potential implications for the field of mental health. I say “potential” because New Mexico is, after all, far from the centers of influence, and it’s possible no one will notice. But it’s a bold precedent. The intent … Read more

When Tim Stezzi and Tim Search launched Managed Care in 1992, the backlash against its eponym was in full swing. Hundreds of bills had been introduced in state legislatures the year before to curb the perceived excesses. Utilization review was being questioned, gatekeeping disparaged. “It… News Wire Coronavirus Outbreak News: 17 dead, 500 infected, 3 … Read more

The merchandise –coming in at $300 each two-pack, significantly less than half of the Brand-Ed med’s set price–will probably hit pharmacy shelves per week,” Mylan said. The Epi-pen Copy-cat is a remedy Mylan vowed After Congressional questions regarding its pricing–that moved from $100 from 2008 to more than $600–sparked people outcry. The generic statement did … Read more

Human beings are not machines, and modern medicine needs to move beyond the repair shop mentality. Could nontraditional services help? Albert Einstein said that you cannot solve a problem with the kind of thinking that is creating the problem. Modeling our health care system after the machine repair shop has forced us to make difficult … Read more

International paying for prescribed medication at 2020 will likely be $1.3 billion; the usa alone will probably pay ~$350 billion. These superior spending prices are predicted to rise at an interest speed of 3–6 percent yearly worldwide. The size of growth is much more alarming for cancer treatments that accounts for a huge percentage of … Read more

MANAGED CARE September 1999. ©1999 MediMedia USA John A. Marcille It’s a problem, all right. Patients aren’t just complaining any more. As forgotten players in what all too often seems to be a tug of war in many directions, patients — the ultimate consumers of health care, are making their presence felt. A few years ago they … Read more

Therapy dogs are critters which improve your wellbeing giving emotional support. It’s possible to train your pet for considered a therapy dog to supply aid on your own and others. They’re also able to stop by an assortment of preferences, for example nursing or retirement facilities, schools, hospice homes, as well as even hospitals. They’re … Read more

More on the pay-for-performance push. MedVantage, a consulting company, says that more such programs (42 percent) are now aimed at specialty care. But physicians are wary. “There are a lot of established markers for quality care in our specialty, but often even in those, there is disagreement,” Ronald Vender, MD, a partner at the Gastroenterology … Read more

The Cost-Effectiveness of Omega-3 Supplements For Prevention of Secondary Coronary Events Jordana K. Schmier, MA ; Nancy J. Rachman, PhD ; Michael T. Halpern, MD, PhD Dietary supplementation with omega-3 fatty acids in U.S. males is associated with fewer cardiovascular fatalities and lower costs The Cost Benefit to Health Plans of Pharmacotherapy for Alzheimer’s Disease David S. Geldmacher, MD … Read more

Q&A: The Status Quo Must Go! Call it “thinking out of the box” or “pushing the mental envelope” or whatever the buzz words of the day might be: Donald Berwick, M.D., is an outspoken advocate of finding new and better ways to deliver health care. His organization promotes them. And a lot of people are … Read more

Whether you’re contemplating drugs for BPH or erection dysfunction, or bridging involving radiation therapy and surgery for prostate cancer, then you will need to examine your options carefully. More than just a primer to the most popular prostate situations, this exceptional novel consists of round table discussions with experts at the forefront of prostate cancer … Read more

What with lawsuits and poor financial performance, 1999 could hardly be termed a good year for HMOs. Despite those setbacks, the some HMO executives seemed to do OK for themselves. Of course, what’s not shown here is how executives in other industries fare while in the trough. (Remember all those articles about golden parachutes during … Read more

A new report sheds some light on the prevalence of high deductible health plans (HDHPs). People who purchase their health insurance directly are more likely to be enrolled in an HDHP than those with employment-based coverage. Source: CDC/NCHS, National Health Interview Survey Paul LendnerPaul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. … Read more

FEATURE Health Information Exchanges Not Ready for Prime Time Touted as a cost-saving and quality improvement tool, HIEs — public and private — are just beginning to show what they can do HIEs have been MIA, at least up until now. Health information exchanges – trumpeted as a boon to payers, providers, hospitals, and pharmacy … Read more

I was amused and somewhat unsettled when I heard of Kaggle, a company with a novel approach to data analysis. As I understand it, Kaggle is a middleman between companies that have large amounts of data and are looking for certain kinds of analysis and the people or companies that can provide that analysis. But … Read more

After years and years of talk, a community of health plans, governments, and providers is getting serious about the beneficial exchange of health care data Molly Coye’s career arc brings to mind the old Johnny Cash number, “I’ve Been Everywhere.” She was born in Wisconsin, educated in Maryland and California, spent time translating Chinese into … Read more

As CDHPs increasingly penetrate the commercial market , their greatest contribution might lie in funding health services for retirees and in reducing the number of uninsured people by offering affordable insurance. Full text available in PDF ABSTRACT Purpose. Consumer-directed health plans (CDHPs) are a new health insurance product that is of growing interest to employers who … Read more

Employers typically want to offer the most cost-effective health benefit package, even if employees feel more of a financial pinch. There has been concern that generalized cost sharing increases under high-deductible health plans (HDHPs) could have some undesirable effects, such as reducing use of medications that are excluded from the deductible. But a new study … Read more

William Silverman, MD, FAAP Pediatric Medical Director, Horizon/Mercy, Trenton, N.J. William Silverman, MD, FAAP Pediatric Medical Director, Horizon/Mercy, Trenton, N.J. Also available in PDF Introduction On June 19, 1998, the Food and Drug Administration licensed palivizumab, as the first monoclonal antibody introduced into clinical practice for the prevention of an infectious disease, respiratory syncytial virus … Read more

  Paul LendnerPaul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen Expertenstatus nachweisen, liefert er unseren Lesern nicht nur Mehrwert, sondern auch Hilfestellung bei ihren Problemen. www.managedcaremag.com

Cancer patients talking to doctors doesn’t work very well: Half of all symptoms go unreported. Computerized systems and email prompts may do a better job. If you want to understand cancer treatment from the patient’s point of view, Wit is a good place to start. You can watch the first-rate HBO version of the one-act play by … Read more

The Third U.S. Preventive Services Task Force released its first of 70 sets of recommendations about the value of specific preventive services. The USPSTF grades the strength of evidence for preventive services from A (strong recommendation) to D (recommends against), or I (insufficient evidence). Among interventions receiving an A: that primary care physicians screen all … Read more

  For Autoimmune Ills, Biologics Bring Promise—and Problems These medications have revolutionized the treatment of conditions like rheumatoid arthritis. But they are budget busters and have a tricky side effect profile. Katherine T. Adams Peter Wehrwein Plans Favor Product Preferencing To Tame Spending on Biologics Insurers apply this management technique to medical pharmacy spending, which … Read more

Medicare considers going beyond palliative care, and Aetna finds that allowing curative treatment and loosening admission criteria reduce costs and improve quality of life Medicare has been credited with a wide range of payment innovations that were later embraced by private health plans, but when it comes to benefit design, most experts think of private … Read more

For years, payers, benefit-design specialists, and others have talked about the “biologics wave” — a tsunami of costly targeted biologics and other specialty drugs achieving FDA approval. In 2013, the wave crashed ashore. Of the 27 drugs receiving FDA approval in 2013, 13 are biologics and specialty drugs. A new report from Evaluate Pharma predicts … Read more

The Abrupt appearance of This Medication fentanyl in the Usa has driven up Illness deaths radically, even while the misuse of heroin and other opioids indicates signs of stabilizing. From the most-comprehensive investigation yet of this catastrophe, researchers advocate that innovative new approaches be chased as the outbreak is similar to many others who have … Read more

With the approval of Breo Ellipta in May 2013 and Anoro Ellipta in December 2013, formulary decision makers are faced with more treatment options for chronic obstructive pulmonary disease (COPD) than ever before. There are now three inhalers that are combination products of a long-acting beta agonist and a glucocorticoid that can potentially help patients … Read more

MANAGED CARE August 1998. ©1998 Stezzi Communications The debate among state legislators and managed care regulators about coverage of Viagra, Pfizer’s popular anti-impotence medication, continued on two fronts last month. A number of states rejected a federal order that Medicaid programs cover the drug. And legislators in California called for an investigation of commercial health insurers that … Read more

Plans prod hospitals to do a better job of addressing problems that kill nearly 100,000 Americans a year As the public reels from the new estimate that nearly 100,000 Americans are dying each year from infections associated with health care, some health plans are taking a lead in alleviating the problem in their markets. “The … Read more

A significant gap exists between how a health care premium dollar is spent and how patients perceive it’s being spent, a new Zogby survey reveals. Respondents believe that 49.5 percent of premiums are spent on medical care, 26.8 percent on insurer’s business expenses, and 23.7 percent goes to profit for the insurer. In reality, 90 … Read more

An FDA-funded study may be a precursor to U.S. registries for tracking real-world outcomes. In Congress, another try at a device tax repeal is afoot. Researchers from Kaiser Permanente, Weill Cornell Medical College, and worldwide registries are voicing the importance of tracking the safety and effectiveness of medical devices through the use of device registries. … Read more

Adults at the USA spent on medications for both diabetes and higher cholesterol as well as other metabolic ailments compared to any different class of medicines from 2006. Expenses for metabolic representatives totaled $38.1 billion, or 18.3percent of overall inpatient medication costs for non institutionalized adults 18 decades and elderly. Expenditures to your most effective … Read more

InterStudy’s director says that the push for patients’ rights has grown into a concern for quality directed mainly at doctors. Richard L. Hamer is director of InterStudy Publications in St. Paul, Minn. Founded as a public-policy group by Paul Ellwood Jr., MD, in 1971, InterStudy and its staff helped draft the HMO Act of 1973, … Read more

“Many of us had hoped that medicine would be better than other fields,” says Reshma Jagsi, director of the University of Michigan’s Center for Bioethics and Social Sciences in Medicine. She thought doctors wouldn’t behave “like this.” Time magazine called them the Silence Breakers. Five women, including Ashley Judd and Taylor Swift, featured on the magazine’s … Read more

Beyond x-rays: a pricey picture Patients and their doctors are so hooked on new ultrafast machines that see inside the body and produce photo-sharp pictures of everything from tiny clogged arteries to athletes’ torn tendons that radiological tests are threatening to overtake pharmaceuticals as the fastest-growing component of health-care costs. [Boston Globe 2001-01-12]   Back … Read more

Blue Cross of California has decided to move away from the traditional managed care incentive of rewarding physicians for controlling medical costs, and instead will implement a program in which physicians receive bonuses for quality of care and patient satisfaction. The shift of Blue Cross, one of the nation’s largest health plans, toward rewarding quality … Read more

Immunotherapy for Advanced Prostate Cancer: A Novel Treatment Option to Improve Survival Prostate cancer is the second leading cause of cancer death in men in the United States. According to the American Cancer Society an estimated 240,890 new cases of prostate cancer will be diagnosed in 2011 and 33,270 men will die from the disease. … Read more

The AMA has withdrawn its backing of employer-sponsored health insurance in favor of promoting individually owned policies. Its House of Delegates voted in December to support individually purchased insurance as “preferred method.”insurance as the “preferred method” to cover employees. The AMA has historically supported employer-provided insurance and just three years ago backed a federal bill … Read more

How do you find out whether a given capitation rate will be profitable for your practice? Activity-based cost accounting is one tool that can help. An accountant explains how it works. The last 10 years have brought substantial changes to the health care industry. Managed care fee reimbursement structures have many physicians working harder, but … Read more

But physician groups say that nurse practitioners lack the training needed to practice on their own. The NPs and docs are fighting it out in statehouses around the country. There is a map of Oklahoma color coded by the counties designated as medically underserved. The areas that don’t have enough doctors are green and those … Read more

Public fascination with alternative medicine gives health plans a can’t-miss business opportunity. Science may determine whether plans’ interest lasts. Michael D. Dalzell Senior Editor JUMP IN NOW, ASK QUESTIONS LATER Anyone who thinks he is having a flashback, raise your hand. The popularity of alternative medicine has a 1960s feel to it: natural products, an … Read more

Once in a while something comes up that requires the sort of immediate and intense intervention that’s downright heroic Let’s start with the happy ending. On March 30, the Food and Drug Administration, in a highly unusual move, ruled that compounding pharmacies could still sell 17 hydroxyprogesterone caproate (17OHP), used to prevent babies from being … Read more

Researchers find potentially “druggable” targets The largest analysis of breast cancer cell function to date has suggested dozens of new uses for existing drugs, new targets for drug discovery, and new drug combinations. The results of the study, which was conducted by researchers in New York City and Toronto, were published online in Cell. “This study … Read more

MANAGED CARE June 2010. ©MediMedia USA Researchers at the Dartmouth Institute for Health Policy and Clinical Practice argue that large medical groups could be well positioned to serve as accountable care organizations (ACOs), according to an article in Health Affairs. ACOs are provider-led, local health care delivery systems that would accept responsibility for the continuum … Read more

Hermes spent 3 years practicing naturopathy, a broad-reaching kind of alternative medicine that centers around”natural” maintenance, including herbal remedies, including acupuncture, and also the discredited practice of homeopathy. However, unease of a colleague ethics directed her to look more closely in her livelihood and exactly what she found alerted her. Therefore for the past two … Read more

Fueled by slowdowns in both private- and public-sector spending, health care expenditures in the U.S. rose 4.8 percent in 1997 — the lowest rate of increase since the government began keeping statistics in 1960. (See charts) But the Health Care Financing Administration, which released the tallies last month, warned that higher medical inflation was likely … Read more

Confounding conventional wisdom, researchers writing in the New England Journal of Medicine have found that the spread of managed care during the past decade has not reduced the amount of time spent with patients. In fact, physicians in 1998 spent one to two more minutes with patients than in 1989, when managed care’s rapid expansion … Read more

Costly protease inhibitors work well in many patients, but call for careful monitoring In less than a year, two new protease inhibitors — telaprevir (Incivek) and boceprevir (Victrelis) — have changed the standard of care for hepatitis C by introducing a new mechanism of action, but their significance goes beyond that. They are the first … Read more

Costly protease inhibitors work well in many patients, but call for careful monitoring   In less than a year, two new protease inhibitors — telaprevir (Incivek) and boceprevir (Victrelis) — have changed the standard of care for hepatitis C by introducing a new mechanism of action, but their significance goes beyond that. They are the … Read more

Twitter and Facebook are good places to promote a health plan’s brand, and they can help members by reinforcing positive behaviors Back in early 2008, the not-for-profit Minnesota-based insurer HealthPartners decided to create a presence for itself in the newly emerging world of social media. Rather than promote the insurance side of the business, though, … Read more

FDA lists 58 medications in short supply July 12, 2016 In hospitals nationwide, workarounds to compensate for medication shortages are daily routines for treating patients––and health experts say it’s not about to change any time soon, according to a report from WNPR News. Acute-care drugs in short supply nationally include antibiotics, antipsychotics, intravenous saline, and … Read more

DM Program Parts for Sale (Some Assembly Required) Some HMOs have created a third way when confronted with the question of building or buying a disease management program. Frank Diamond Helping Hands for HEDIS High-quality care is only part of the secret to scoring well on HEDIS. Understanding how to ‘do’ HEDIS is equally important. … Read more

With today’s immense pressure on Medicaid budgets, states can’t extend DM programs fast enough. The grim financial crisis that confronts most state governments may be one of the best things that ever happened to the disease management business. Caught on the horns of a budgetary dilemma — hooked by soaring medical prices and tumbling tax … Read more

When a new UCR database is created, how will health plans change their out-of- network payment policies? Almost two years ago, Health Net signed off on a settlement of three class-action lawsuits that would have far-reaching — and very expensive — implications for the managed care industry. The health plan agreed to pay $215 million … Read more

POPULAR CONTENT TODAY’S POPULAR CONTENT Type Title Author Story Insurers Find Small Gains In Weight Control With Belviq webadmin Story Stressed States Open Doors to Medicaid Managed Care webadmin Story Molecular Diagnostic Testing Presents $5 Billion Conundrum webadmin Story AMA applauds claim processing improvement webadmin Story Tougher CMS Readmissions Rules Afflict Hospitals at a Bad … Read more

Hundreds of hospitals and thousands of physicians are participating in bundled payment programs, and most bundled payment contracts have upside and downside risk, according to François de Brantes, executive director of the Health Care Incentives Improvement Institute (HCI3). “We’re now in the scaling phase of this payment model and no longer in pilot or early … Read more

Experts Launch Antibiotic Stewardship Playbook Publication outlines implementation strategies in acute care   According to the Centers for Disease Control and Prevention (CDC), drug-resistant bacteria cause two million illnesses and 23,000 deaths annually. The National Quality Forum, a nonprofit organization, has convened more than 25 experts and national stakeholders from the public and private sectors … Read more

Last month, the patent for Claritin, Schering-Plough’s blockbuster nonsedating antihistamine, ran out. This opened the door to competition not only from generics, but also from Schering’s own over-the-counter version of loratadine. Yet, for some time, Schering has been working to convert physicians and their patients to Clarinex. Claritin is approved only for seasonal outdoor allergies, … Read more

Nine out of ten Medigap recipients say that they are so happy with the coverage that they’d recommend it to friends and relatives who turn 65, according to a survey by America’s Health Insurance Plans. Medigap has always been popular, but the 91 percent is even higher than reported in 2009 (87 percent) and 2005 … Read more

Snapshot of a growth industry The Disease Management Purchasing Consortium & Advisory Council tracks the growth and success of the industry, based on first-hand information from the roughly 70 percent of all purchases of DM programs that go through the consortium, and from information gleaned about the other 30 percent. The numbers the organization has … Read more

A summary of the ECRI Institute’s Emerging Technology Evidence Report Sleeve gastrectomy is a surgical procedure that reduces the size and volume of the stomach, thereby restricting food intake while preserving the stomach’s function and enabling weight loss. Gastrectomy is known as a restrictive procedure in contrast to a malabsorptive procedure that inhibits food absorption. … Read more

Plans try to figure out how to deal with federal guidelines on services that take effect next month John Carroll The U.S. Preventive Services Task Force has quietly labored behind the scenes for 26 years with the charge of developing the gold standard for preventive medicine. But the low profile the 16-member group has enjoyed … Read more

“Magic bullet” remains elusive Emergency patients treated with naproxen and placebo had outcomes as good as or better than patients treated with naproxen and diazepam (Valium, Roche) for acute lower back pain, according to the results of a double-blind, randomized clinical study published in the Annals of Emergency Medicine. “Our study contributes to the growing body … Read more

Adult patients without health insurance admitted to intensive care units (ICUs) in Pennsylvania hospitals are at a 21 percent increased risk of death compared to similar patients with private insurance, according to researchers at the University of Pennsylvania. The difference in mortality risk was not explained by patient characteristics or differences in care at the … Read more

It is oft lamented that America’s health care system lags behind other segments of the economy in its use of information technology. As a medical informaticist, Ross D. Martin, M.D., M.H.A., makes it his life’s work to erase that deficit. Martin is a postgraduate fellow in medical informatics at the Decision Systems Group, a medical … Read more

Price comparison can be really a simple element of rivalry. For contrast to work, at the least prices will need to become transparent. More over, price is generally a focus in consumer thinking and selecting trades. Thus, obfuscating prices might be damaging for consumers. Because of this, it’s essential for policy makers to know the … Read more

Many problems attributed to outcomes measurement result from poor planning before a program is initiated. A DM expert lays down some ‘must-do’ rules for success in this excerpt from Disease Management and Wellness in the Post-Reform Era, published by Atlantic Information Services Inc. Perhaps no issue in disease management (DM) is more controversial than outcomes … Read more

A proposed research institute would pit medications against each other instead of against placebos, and that might save $368 billion over 10 years In many late-stage clinical trials, a new therapy has only to prove that it’s safe and significantly better than a placebo to win approval by the FDA. That system has often spawned … Read more

Network Health Alliance uses a team approach to bring primary care to an often hard-to-reach — and very costly — population Health reform’s emphasis on the patient-centered medical home is the exclamation point on evaluation and experimentation with this delivery system that has been going on for several years — and that promises to continue. … Read more

Single-dose option cleared for acute bacterial skin and skin-structure infections The FDA has approved a supplemental new drug application (sNDA) to update the label for dalbavancin (Dalvance, Allergan) for injection. The expanded label will include a single dose administered as a 30-minute intravenous infusion of dalbavancin for the treatment of acute bacterial skin and skin-structure … Read more

Aetna’s national medical director for oncology solutions argues that “variation almost never yields a superior result.” Stick to optimized practices. I read that you are board certified in internal medicine and oncology. What drew you to oncology? Funny story. I went to medical school at Washington University in St. Louis, which is one of the … Read more

‘Population-Based,’ Meet ‘Patient-Centered’ Two vaunted ideals of health care, experts say, should be perfectly aligned. And they almost are. Timothy Kelley How To Combat Pharma’s Costly Coupon Programs When drug manufacturer coupons make members’ costs for brand drugs equal to generics — or less — health plans, employers, PBMs, and members pay a price Linda … Read more

Drug approved last April for treatment of adults with tardive dyskinesia The FDA has granted an orphan drug designation to valbenazine (Ingrezza, Neurocrine Biosciences) for the treatment of pediatric patients with Tourette syndrome, a neurological disorder characterized by motor and vocal tics. Tourette syndrome becomes evident in early childhood or adolescence. Valbenazine, a novel selective … Read more

The major mobile communications companies are among the players that hope to cash in as technology meets growing needs Medical device manufacturers in the United States — the largest medical device market in the world — expect to see a 7% or more increase in sales in the coming years. In 2013, the medical device … Read more

Don’t look now but the only thing falling in terms of health care costs seems to be the rate of increase of premiums — good news for employers and other purchasers. Preliminary results from the 2006 Group Health Insurance Survey indicate the lowest average premium increase in seven years. In fact, this is the fourth … Read more

STATE INITIATIVES Wisconsin’s largest HMO is dropping out of the state employee health plan, saying that continuing would not be economically feasible. PrimeCare Health Plan, a unit of United HealthCare Corp., had proposed a 19-percent premium increase for state workers in 1999, but on Sept. 1 told the state that it was dropping out, effective … Read more

It’s widely recognized in tiny studies which provider version from healthcare recommendations and patient drug nonadherence contribute to less than optimal overall health effects, increasing expenses, and greater usage. A retrospective analysis of administrative claims data from the large national agency was conducted.The study analyzed multiple quality signs exemplifying naturopathic medication and drug adherence for … Read more

In addition to the 85 percent rule, the department is applying a ‘reasonableness’ criterion. But it’s all bark, no bite. John Carroll As 2010 was winding down, the Department of Health and Human Services took one final poke at the managed care industry. In carefully detailed language posted in the Federal Register, regulators took their … Read more

Endstage renal disorder is an increasing medical problem in Saudi Arabia because rising incidence and incidence prices. The entire quantity of patients that are receiving renal replacement therapy was rising rapidly lately, whilst the Saudi Centre for Organ Transplantation statistics have demonstrated. This analysis aimed to ascertain the frequency and reason for chronic kidney diseases … Read more

(nivolumab) may be utilised as an adjuvant treatment of specific melanoma patients, to forbid their cancer from coming. People who have metastatic melanoma that experienced a total resection, to utilize Opdivo being a means to reduce relapse. “Now’s endorsement builds our direction into melanoma, offering Physicians a new option with all the capability to alter … Read more

Americans’ girth is growing at an alarming rate. Many are too sedentary, too stressed, suffering from insomnia, making bad food choices. The drumbeat of “We need a culture of health versus a sickness culture” is a refrain that we now often hear and that I have espoused. Yet we advance this form of health and … Read more

Only 0.4% of older surgery patients show persistent opioid use With the abuse of opioid painkillers a major public health threat in the United States, many worry that postsurgical use might trigger addiction. But a new study suggests that painkiller abuse is a problem in only a small fraction—less than one-half of one percent—of patients … Read more

MANAGED CARE June 2000. ©2000 MediMedia USA Bowing to public condemnation, Kaiser Permanente will no longer require psychiatrists to write prescriptions for some patients they have not seen. The not-for-profit organization says its psychiatrists now will examine all patients before a prescription is written. A San Diego psychiatrist filed suit against Kaiser, claiming it fired him after … Read more