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PTCommunity news

New drug approvals, clinical trials, drug management. Three times per week.

Payers

Commercial insurers, the employer and individual market, plus Medicare trends, Medicare Advantage, & Medicaid managed care
Joseph Burns
The CNN story once again puts controversy about prior authorization into the spotlight. But is it necessary to review the entire medical record?
Frank Diamond
Molina finances the care, but the provider-patient encounter is where the deal is truly sealed, says Karl Brown, MD. “When we can create more value in an encounter, that’s a beautiful thing.”
Karl Brown, MD, the chief medical officer of Molina Healthcare of Utah, emphasizes that growing up he didn’t have it as bad as most of the Medicaid beneficiaries he’s responsible for. But he did learn how to tough out an illness. “If you were sick, you just hoped you got through it OK,” says…
Sarah Kwon
Building on a similar effort in California, Catalyst for Payment Reform is proposing a standardized set of 50 ACO measures. Some of the country’s largest purchasers are taking it to their health plans.
Interview by Peter Wehrwein
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.

Career Opportunities

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising.  Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

Apply via email to jfedder1@hfhs.org or online at http://p.rfer.us/HENRYFORDlXqAJA

Women’s Health
Lola Butcher
High Caesarean section rates. Too many babies in the NICU. There are indications that maternity and newborn care in this country is far from ideal. Some payers are betting that bundled payments for obstetricians will create incentives to make changes and reduce low-value care.
Joseph Burns
A MedPage Today blog post suggests that they do. Industry veterans say they’re unaware of bonuses for denials but agree prior auth processes should be more transparent.
Vox medical directorae
Lola Butcher

They are all physicians. They all want to take care of people. But the chief medical officers at health plans and provider organizations often see the world through different lenses. Here, chief medical officers from both sides of the divide share their views.

Timothy Kelley
Medical directors have been around for a long time. Today, to reflect expanding duties, there’s a bewildering array of other titles too. Are we all agreed on what titles mean, then? No way. For example: Many executives who are called CMOs—or something else—are also taking on the new duties of value-based care.