Author John Sung Kim, the CEO of DoctorBase, recently had a close encounter with the health care system. The cost for an overnight stay in a hospital without surgery? Try nearly $50,000. The insurer paid about $35,000 and the rest was “forgiven.” How’s that?
Talk about throwing water on a grease fire. A study in the journal Cancer reports that more than two-thirds of breast cancer deaths occur in younger women, specifically those under 50. The U.S. Preventive Services Task Force ruled in 2009 that routine screening begin at 50, and there’s been heated debate ever since.
More employers will take up consumer-directed health plans in the coming years, according to the Aon Hewitt 2013 Health Care Survey. Employers who are considering CDHPs are interested in both health reimbursement accounts, and health savings accounts. And, of course, it’s a way to shift more costs to workers.
Utilization management for outpatients cuts testing rates significantly, according to a review of claims for over 2 million patients. Use declined the most in low- and medium-risk groups. Food for thought for clinician executives as the authors note that there have been few cost-effectiveness studies on this.
Existing therapies reduce morbidity and mortality by only 50% of heart failure patients. Disease modifying medication therapies have not yet been demonstrated to work conclusively for individuals with heart failure with preserved ejection fraction. Ejection fraction is the percent of the ventricular volume that is pumped out with each heartbeat.
Short answer: maybe. Attempts in the past have failed and a lot will need to happen this time to make it work. What consumers have for comparing physicians and hospitals is woefully inadequate, for the most part. The good news: Some health plans have the best tools around.
Nowadays, every turn of a newspaper page, click of a media page on the Internet, or flip to a news channel brings us to an update, or more likely a criticism, of the public exchanges. With all of the attention on this side of the exchanges, we might be forgetting about the private exchange. The private exchange serves as a channel for individuals and employers to purchase health insurance that is separate from the newly opened public exchanges developed under the Patient Protection and Affordable Care Act.
The biggest difference between the two stems from the fact that government subsidies aren’t available to those choosing to purchase health insurance from the private exchange. This explains why much of the news regarding private exchanges focuses on the group market, as employers that choose to participate in a private exchange provide employees with an subsidy to be used toward the purchase of health insurance, a method also known as defined contribution. Continue reading… about What About the Private Exchange?
We eat too much and our increasingly sedentary lifestyles don’t help much either. The U.S. will have about 113 million obese and 81 million overweight people in 2022, according to a study by the consulting company GlobalData. We will far outpace the other eight industrialized nations that researchers looked at.
Independence Blue Cross records impressive savings so far. Addressing obvious areas of waste is easy. Now comes the hard part. The secret will be getting more practices to participate and staying in it for the long run, says Don Liss, the insurer’s senior medical director.
Yes, there’s been a primary care physician (PCP) shortage for years now, and it’s been well-documented (http://tinyurl.com/PCP-shortage). So have the reasons; medical school students following the money to specialties and the Affordable Care Act. Lost in the shuffle: There are a lot more places where patients can get primary care.
Too many physicians in ambulatory settings prescribe broad-spectrum antibiotics for conditions that might require a drug with a narrower focus, according to a study in the Journal of Antimicrobial Chemotherapy. Overuse of antibiotics can cause problems while providing no benefit.
They encourage consumers to use brand-name drugs rather than generics by effectively evening the copayments. That’s only for a limited time, however. They’re hardly ever good for more than a year. By the time the “deal” runs dry, the patient may have developed loyalty to the more expensive product.
Rapid growth in spending on biologics threatens to send pharmacy budgets soaring. A new report by Evaluate Pharma indicates that by 2018, biologics will account for one quarter of all drug spending worldwide — double the share they commanded less than a decade ago.
They’ve always hankered to do more than count pills: things like medication therapy management, immunizations, lab tests, and medication visits. The American Pharmacists Association sees PCMHs as an opportunity to expand their members’ reach in the health reform era. Flexibility is key.
How to keep up with the development of hundreds of new and emerging drugs, devices, and procedures? The Agency for Healthcare Quality offers horizon scanning, in which it tracks emerging technologies and services in clinical stages of research, or very early adoption.
“What’s a reasonable cost?” asks Richard Schilsky, MD, the CMO of the American Society of Clinical Oncology. “A hundred thousand for a few months of life?” Such are the tough questions presented by cutting-edge treatments: questions that can’t be ignored. Oncologists lead a national conversation.
What really motivates people? What motivates patients to take better care of themselves, and physicians to follow generally accepted best practice guidelines? Money is not always the answer. In fact, it can be detrimental, according to a study by the Health Care Incentives Improvement Institute.
The United Kingdom’s debate about linking health with social services pits the National Health System against local governments that control budgets. The two sides do not have a good opinion of each other, to put it mildly. Patients’ concerns take a back seat.
For instance, obinutuzumab (which is getting closer to market) not only attacks cancer cells with the CD20 marker, but it is engineered to stimulate the body’s immune system into fighting those cells as well. To be used for patients with chronic lymphocytic leukemia.
The CEO of the Cleveland Clinic explains what makes this highly respected hospital system so good that it’s success is being exported. Innovative methods pertaining to, for instance, physician engagement are about to go international, with the opening of satellites in Canada and even the United Arab Emirates.
It seems many of us have some preconceived ideas of what new Medicaid members will look like: They’ll be older, sicker, higher utilizers of services and, more challenging to care for.
But when we take a closer look at populations that will qualify for Medicaid over the next several years, a different picture appears. Chances are the new Medicaid member is going to be that part-time waiter at your favorite local restaurant or the young woman with a toddler and another on the way who decided to go back to school. Continue reading… about We Better Not Blow It