Managed Care
News & Commentary
In 2011, 48% of new MA enrollees were new to Medicare and 52% had switched out of the traditional program, according to Kaiser Family Foundation researchers. In past years, a greater percentage came from those who switched from the traditional program.
News & Commentary
Physicians have until February 28 to attest that they’ve met the 17 core requirements for stage 2 for their Medicare and/or Medicaid patients. As of early December, however, only 3,655 eligible providers were paid for implementing stage 2, compared to 268,686 paid for stage 1.
Electronic health records (EHR) cannot stand alone, say researchers in a PwC report. While the number of providers integrating smartphones and tablets into their EHR collection system has risen, there's still a long way to go. More patients want to see this, however, and doctors who want to stay competitive will respond.
Medication Management
Thomas Reinke

Cheryl Larson

Consumer directed health plans (CDHPs) have moved out of the shadows of PPO and HMO plans and into the forefront of employer strategies for health care benefits. Employers need to be more attuned to the longer range cost implications of their CDHP offerings so that employees can pay for their medications.
Frank Diamond

Alan Muney, MD

When the relentless climb in health care spending began to level off in 2002, few experts predicted that we may have turned a corner because economists, to this day, can’t agree on what caused the downturn. Not only does the deceleration continue, but we may eventually talk of decreasing costs.
News & Commentary
A patient-centered medical home (PCMH) geared toward children with costly chronic conditions won health care’s triple crown of improving care, and health, while lowering costs. The question: Can the success documented in a study by researchers at the University of Texas Medical School be broadly replicated?
Tomorrow's Medicine
Thomas Morrow, MD

Thomas Morrow, MD 

Thoracic insufficiency syndrome (TIS) is a collection of rare disorders of the thoracic skeletal system affecting about 4,000 newborns in the United States each year. A machine that’s been evolving for more than two decades can now tackle this agonizing problem, bringing hope to families.
Legislation & Regulation
Richard Mark Kirkner

Nicholas Bagley

A lot of feigns and jabs on the congressional front, but the defining event for the ACA this year will be King v. Burwell, which challenges the legality of tax credits for people who purchase health insurance in states that didn’t set up their own exchanges but used the federal version instead.
Cover Story
Joseph Burns

Lisa Guertin

Money really does talk. Some health plans pay beneficiaries anywhere from $10 to $150 or more to pick low-cost hospitals, imaging centers, infusion sites, clinical laboratories, and other care providers. It seems to be a win-win. The more insurers save, the more financial incentives they give out.
Contributing Voices
Norman S. Ryan, MD
Norm Ryan, MD

As the healthcare industry continues the shift toward value-based medicine, Medicaid plans and providers have two clear avenues to pursue in demonstrating success in managed care and population health that can improve their HEDIS scores:

Managed Care Outlook
And that can lead to a host of societal problems. Osteoarthritis, type 2 diabetes, stroke, Alzheimer’s disease, dementia, respiratory conditions, hypertension, certain cancers, and heart, liver, and kidney diseases all have something in common: Obesity contributes significantly to their prevalence.
Plan Watch
Frank Diamond

Mark Crockett, MD

Initiators of the program hope to supply physicians with both electronic health record and claim information that can be easily obtained, even when patients switch plans. Seven health plans and 74 physician practices are involved in the effort that they hope will enhance care coordination.
Contributing Voices
Peter Wehrwein

Last May, two health advocacy groups filed a complaint with the Office for Civil Rights at HHS accusing four insurers selling plans in Florida of discriminating against people with HIV/AIDS by putting the drugs for treating the condition on the top tier of their formularies.

Researchers at the Harvard School of Public Health have followed up that complaint with their own research into what they are calling “adverse tiering.” The researchers, Douglas B. Jacobs and Benjamin D. Sommers, reported their results in this week’s New England Journal of Medicine.

The Harvard researchers looked at silver-level plans listed in the federal health exchange in 12 states, six with insurers mentioned in the complaint (Delaware, Florida, Louisiana, Michigan, South Carolina, and Utah) and six of the most populous states without any of those insurers (Illinois, New Jersey, Ohio, Pennsylvania, Texas, and Virginia).