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Contributing Voices
Peter Wehrwein

If you're into health care policy and law, tomorrow is your Superbowl, World Series, and World Cup all rolled into one.  

Oral arguments for King v. Burwell are scheduled to start tomorrow at 10 a.m. As Richard Mark Kirkner explained in our February issue, the case could uphold the ACA or severely crimp the law by eliminating premium subsidies in the 34 states that use the federal health exchange.

The ACA has been resilient, and many health care interests would rather live with the law, despite its flaws, than see it come undone.

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:

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).

Contributing Voices
John Marcille

I have been seeing reports from the Workers Compensation Research Institute (WCRI) about physicians dispensing drugs. That this practice still exists surprises and dismays me.

I lived much of my life in New York State, where I had never encountered the practice. I became aware of it only when I was working for a publication that catered to primary care doctors, and of course I thought that it was a great idea because of the convenience.

Contributing Voices
Peter Wehrwein

The use of new hepatitis C therapies will increase rapidly, but the effect on spending is greatest early on, according to a PricewaterhouseCoopers analysis. According to the consulting firm’s projections, the expensive medications will eventually lower health care spending because they will improve the health of people with hepatitis C patients, so liver transplants and other high-cost medical interventions will be avoided.

Source: “Medical Cost Trend: Behind the Numbers 2015,” PricewaterhouseCoopers Health Research Institute, June 2014. PwC analysis based on National Health and Nutrition Examination Survey and 2012 Truven claims data from employers.

Contributing Voices
Steven Peskin, MD

“At first they thought it was anxiety,” Melissa Thomason began her deeply moving and inspirational story.  Melissa’s first pregnancy was complicated by preeclampsia, requiring delivery 5 weeks early by C-section. Her elation was short-lived when she experienced “a bulldozer sitting on her chest and shortness of breath” two hours after her Cesarean delivery. She was told that anxiety is frequent after child birth.

“Thankfully, my OB listened to me and ordered a CT scan of my chest.” A nightmare: The severe pressure, pain and shortness of breath were caused by ...

Contributing Voices
Edie Castello

Technology in health care is in danger of going the way of the home exercise bike: Lots of potential, not enough use — and less-than-optimal results.

Take data analytics, for example. With more health care organizations than ever before using electronic health records, we’re finally getting what we have been asking for: A plethora of really good data that could inform decision making. In 2011, data from the U.S. health care system reached 150 exabytes. As growth continues, big data for U.S. health care will soon reach the zettabyte (1021 gigabytes) scale and ...

Contributing Voices
John Marcille

Anyone who spends much time talking with me knows that one of my concerns, and not just as an editor, is the misuse of language by people in health care. Yes, I have a list of examples, and I might share that in a future essay. Today, we'll consider just one problem.

Contributing Voices
Norman S. Ryan, MD
Norman S. Ryan, MD

As if the worsening diabetes epidemic were not enough to worry about, this chronic condition also increases risk for complications like heart disease, stroke, and kidney failure. This is a major challenge for health plans managing the care of a growing population of Medicaid members, who tend to overutilize emergency rooms for routine or non-urgent care.

While preventive and disease management programs are helping improve outcomes for people with diabetes and other chronic conditions, more must be done beyond just phone outreach to adequately engage Medicaid members. For instance, the single mother with young children and no car doesn’t need a call to remind her of an A1C test; she needs help resolving socioeconomic barriers like lack of transportation or child care.

Contributing Voices
Peter Wehrwein

Three more organizations have exited CMS’s Pioneer accountable care organization (ACO) program, leaving just 19 of the original 32 participants in the fold for the elite program’s third year.

The Franciscan Alliance in Indianapolis, the Genesys Physician Hospital Organization in Flint, Mich., and the Renaissance Health Network in Wayne, Pa., in the southeastern part of the state, are leaving the Pioneer program, according to a list posted on the CMS website this afternoon.

Sharp Healthcare in San Diego had announced in August that it was dropping out.

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