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This month we will narrow our look at the Stark II regulations, exploring their effect on income division. This arises in such contexts as how physicians are paid by their employers and contracting providers, and whether a medical group falls within the law’s “group practice” definition. Most frequently, the Stark law’s rules about revenue division … Read more

Restricted Maintenance is an interest for that we have an enormous passion and that I apologize in advance for almost any biases I’ll bring into the table, because I believe that handled medical care is a outstanding vehicle for its delivery of care to exposed people in the event medical plans are put up precisely. … Read more

ACO UPDATE Pioneer ACOs: Some Unhitch Wagons While Others Roll Over Rocky Terrain Savings generated by the CMS program are not impressive, but quality measures show improvement Editor’s Note: ACOs may not be here to stay, but then again, they may be with us for some time. With this issue, Managed Care begins monthly coverage of … Read more

Kaiser Permanente’s experience proves that plans play a valuable role in ensuring that all Americans have access to care MANAGED CARE April 2009. ©MediMedia USA Kaiser Permanente’s experience proves that plans play a valuable role in ensuring that all Americans have access to care As an integrated delivery system, Kaiser Permanente serves as an especially good environment … Read more

COVER STORY House Call Revival, Digital-Style Telemedicine has different aspects, and one is the seemingly simple connection of a doc and a patient. When the stars are aligned, such an encounter can save money and time. Emergency physician John Wilkinson returns home from a busy nine-hour shift in a high-traffic hospital. The 63-year-old doctor changes … Read more

First buprenorphine augmentation to that maintenance treatment of opioid addiction. Probuphine was made to supply a steady, low dose dose of buprenorphine for 2 months from patients that are more stable on low-to-moderate dosages of different kinds of buprenorphine, as a portion of an entire treatment method. Until now, buprenorphine for your Treatment of opioid … Read more

Just about everyone except the patient is offering some kind of incentive to do something, but beware of unintended, not to say unwanted, outcomes: the notorious perverse incentive Frank Diamond Managing Editor The influence of incentives in our lives can possibly be overstated, though that would take some doing. The world-famous health care economist Uwe … Read more

MANAGED CARE July 2008. ©MediMedia USA John Marcille Isn’t it encouraging to hear more evidence of the success of consumer-directed health care? By which I mean the idea of making members put some skin in the game, as the overused metaphor has it. Just what success do I refer to? Well, there is that report from the … Read more

Injected Device Shown Effective in Reducing Fecal Incontinence Thomas Morrow, MD For this condition that is largely confined to the Medicare population, a new treatment is now available MANAGED CARE September 2011. ©MediMedia USA For this condition that is largely confined to the Medicare population, a new treatment is now available Thomas Morrow, MD Most people reading … Read more

Association health plans provide a simple lesson on the wide political divide over the direction of health care reform. John Carroll Jim Talent was mad. It was two years ago, and Talent — a member of the U.S. House of Representatives and a rising star in the Republican party — was trenchantly defending his new … Read more

Reducing cost of care is their top priority The Republican strategy of repealing the Patient Protection and Affordable Care Act (PPACA) before devising a replacement plan has the support of only one in five Americans, according to a new survey by the Kaiser Family Foundation. The poll also disclosed that shrinking the federal government’s involvement … Read more

SNAPSHOT Decline in cervical cancer death rate ends The number of deaths caused by cervical cancer remained stubbornly stable from 2007 to 2011. Millions of women do not use simple screening procedures, according to the Centers for Disease Control and Prevention. About 8 million women between 21 and 65 in 2012 hadn’t had a Pap … Read more

The current armamentarium against Alzheimer’s disease consists only of drugs that provide symptomatic relief, and the benefits are modest at best. Medications that can stop, slow, or prevent the underlying pathophysiology of Alzheimer’s disease are desperately needed. Change in age-adjusted death rates for selected causes of death for all ages, by sex: U.S., 2003–13 CLRD=Chronic … Read more

Treatment prolongs disease-free survival The Sunitinib Trial in Adjuvant Renal Cancer (S-TRAC), a phase 3 study of sunitinib (Sutent, Pfizer) versus placebo in the adjuvant setting, has met its primary endpoint of improving disease-free survival (DFS) in patients with renal cell carcinoma (RCC) who were at high risk for recurrence after surgery. S-TRAC is the … Read more

It doesn’t take much to help reduce the stress a patient experiences in a clinical setting. Be mindful of surroundings. Kim Baughan-Young MANAGED CARE November 2001. ©MediMedia USA PRACTICE ENVIRONMENT It doesn’t take much to help reduce the stress a patient experiences in a clinical setting. Be mindful of surroundings. Kim Baughan-Young Lively, colorful chairs lend cheer to this … Read more

The former senior VP for health policy at UnitedHealth Group joins a company that aims to shift power from HMOs to patients and physicians. Lee N. Newcomer, M.D., could well have ended up as a lawyer or a biologist. A draft number of 25 in the early 1970s prompted him to apply to various graduate … Read more

This Is a Frequent scenario: A Person Registers in to a hospital for Operation or An disease and leaves with a prescription for the opioid pain killer, opening the doorway to longterm usage and dependence. Even a recent analysis analyzed this blueprint and found that the prescriptions are properly used and revived more frequently than … Read more

The age of the “Super Blues” may be dawning, thanks to the consolidation of Blue Cross and Blue Shield health plans. That’s the opinion of some experts after Anthem’s $4 billion purchase of Trigon Health Care. There are 43 Blues plans today, far fewer than what existed in earlier years. Mike Taylor, a principal with … Read more

Mean expenditures for the 10 most costly medical conditions for both men and women, according to the Agency for Healthcare Research and Quality, were highest for cancer at $4,873 for men and $4,484 for women. For heart disease, the average expenditure was $3,723 per woman and $4,363 per man. Source: 2011 National Health Insurer Report … Read more

The Texas attorney general’s decision in the Aetna case is the latest in a long string of events that has gutted the fundamentals of managed care. Many in health care think that some or all of these developments — taken together — have stripped health plans of their ability to manage care effectively. April 2000 … Read more

In nonconforming states, health plans will miss out on a bonanza of new members and hospitals might be on the hook for uncompensated care John Carroll While the Supreme Court’s majority opinion left the Affordable Care Act largely intact, it stripped away one provision that some of the most potent forces in the health care … Read more

By Jean Lawrence Contributing Editor At first blush, it seems so simple. Post-surgical infections, high Cesarean-section rates, deaths following cardiovascular surgery: These are negatives for health care organizations. So why not accredit only organizations demonstrating good results? Each year, the Joint Commission on Accreditation of Healthcare Organizations evaluates 18,000 such entities and programs in the … Read more

Frequent antidepressants socialize with all the opioid pain drugs tramadol to produce it not as effective for pain relief,” says that a brand fresh study in University Hospitals. These findings have major consequences because of the outbreak, implying that a few patients imagined drug-seeking can in reality be under-medicated and are trying to find far … Read more

John Marcille Television news outlets scream for attention every minute of every day. Newspapers sometimes have three or four stories that might deserve the headline above the fold; sometimes nothing makes the grade. Still, they publish even when news is slow. There always has to be a headline or lead story. One day it may … Read more

On Dec. 6, 1946, a 3-week-old boy was admitted to the Hospital for Sick Children in Toronto. The tiny child was suffering from weight loss and seizures. His mother told doctors that he turned blue when he cried but now his crying sounded different—he wailed as if in pain. The child’s bones were in terrible … Read more

For physicians in multispecialty groups or in groups with multiple locations, the Stark II regulations offer some guidance on how income should be distributed. Even so, ambiguities exist. For instance, Stark requires that group practice overhead and income be distributed according to methods “previously determined.” Those methods must be in place before the doctors in … Read more

Q&A The director of Kaiser Family Foundation’s Changing Health Care Marketplace Project says physicians will soon call more of the shots. For the last two years, Larry Levitt has directed the Henry J. Kaiser Family Foundation’s Changing Health Care Marketplace Project and its California grants program. There, he directs the work of the health care … Read more

This complex automated clinical record system promises pharmacoepidemiologic research of some high quality and volume not before possible. Pharmacoepidemiology provides responses in regards to the validity of favorable and adverse medication events and assists in individualizing drug therapy. When CHCS sooner or later encircles around 9.1 million patients in 166 military associations and 588 clinics … Read more

Provider groups carrying on risk to the over all costs of maintenance accountable care businesses are growing care management software to increase care and thereby restrain expenses. Many such programs aim”high-need, high-cost” patients: people who have multiple or intricate conditions, frequently along with behavioral health issues or behavioral difficulties. Within this analysis we compared the … Read more

Insurance industry executives from Anthem, UnitedHealth, Health Net, Kaiser Permanente and Aetna, along with California insurance commissioner Steve Poizner, have joined to ensure that patients can transfer their personal health records (PHRs) between insurance companies. A PHR is a tool used to manage an individual’s medical information. Nearly all insurers offer PHRs, but few patients … Read more

Our Metaanalysis implies both people with type 1 DM may have a heightened risk for virtually any fractures. A significant prospective epidemiological analysis is necessary to ensure that our findings. Impairment in sugar homeostasis was proven to improve BMD and bone structure. Most, however, maybe not all studies have revealed that BMD is diminished in … Read more

The $60 billion to $108 billion that could be saved through tort reform would help 2.4 million to 4.3 million uninsured get coverage, the government claims. John Carroll Depending on which side of the political divide you sit, federal medical malpractice reform limiting noneconomic damages on medical cases to $250,000 would: Carve a whopping $60 … Read more

The outcomes for those patients are poor technically in contrast to folks who develop p novo AML. The variety of cytogenetic abnormalities at t-AML is very similar to p novo AML, however the frequency of adverse cytogenetics, like some intricate karyotype or deletion or loss of chromosomes 7 or 5, is significantly greater in t-AML. … Read more

FDA releases new data   The number of potentially deadly infections from contaminated medical scopes is far higher than what federal officials previously estimated, according to a report from Kaiser Health News. New data released by the FDA has indicated that as many as 350 patients at 41 medical facilities in the U.S. and worldwide were … Read more

In top-line results, adverse events were also similar   July 21, 2016   Results from a phase 3 study evaluating the efficacy and safety of biosimilar ABP 980 compared with trastuzumab in patients with human epidermal growth factor receptor 2 (HER2)-positive early breast cancer have ruled out inferiority compared to trastuzumab but could not rule … Read more

Some vendors are moving from offering just a few programs to embracing systems that try to deal with all the complicated overlaps. By John Carroll Contributing Editor In the early days of disease management, tackling even one of the top chronic ailments was a stiff challenge. Today, inside CorSolutions, the push is on to handle … Read more

In theory, this approach could help untangle some knotty cost and quality concerns about medications as they move from clinical trials and into clinical use. But there’s that credibility issue. First of two parts The idea of using real-world evidence to improve health care is really something of a no-brainer. It’s just plain common sense. … Read more

A summary of the ECRI Institute’s Emerging Technology Evidence Report Editor’s Note: Managed care leaders are striving to make evidence-based decisions about new and emerging health technology. MANAGED CARE and ECRI Institute have collaborated to disseminate bimonthly summaries of the Institute’s Emerging Technology Evidence Reports. ECRI Institute is an independent not-for-profit organization that researches the best … Read more

Frustrated With Managed Care ‘Lite,’ Radicals See Virtue of Competition As employers try to get workers to pay more and shoulder more risk, there’s another way to control cost – one that promotes quality as well. Marlene Piturro, PhD, MBA The Uninsured: How Health Plans Can Do Well By Doing Good While health plans battle … Read more

Plans looking for a low-risk way to experiment with new benefit designs might start with the pharmacy benefit. Tony Berberabe Associate Editor If “consumer-directed health care” is the hottest catchphrase on everyone’s lips, surely the next phrase to follow is “pharmacy benefit.” And while a consumer-directed pharmacy benefit is offered by only a few plans … Read more

“Academics for hire” shape pricing debate To help promote their expensive new cures for infection with the hepatitis C virus (HCV), three major pharma companies––AbbVie, Bristol-Myers Squibb, and Gilead Sciences––recruited the consulting firm Precision Health Economics, whose roster includes leading economists and health care experts at the nation’s top universities. When AbbVie funded a special … Read more

Turn around for just one second and health plans find all sorts of issues racing toward them. There is, of course, the ferment taking place in the pharmacy benefit management industry that Thomas Reinke ably examines in our cover story. Developments on deadline include Karen Ignagni, president and CEO of America’s Health Insurance Plans, pointing out … Read more

Type Title Name Story Preventive Care Drives Surge in Use of Clinics webadmin Story Using Virtual Assistant Technology to Improve Outcomes, Adherence webadmin Blog entry Decreasing Medical Costs: How Insurers Are Taking the Easy Way Out Archelle Georgiou MD Blog entry A Tale of Two Doctors Steven Peskin MD Story New Hepatitis C Regimen Stimulates … Read more

W​e’ve been hearing the figure at least since 2011, when the first baby boomers turned 65 and became eligible for Medicare: Each day now, 10,000 Americans cross that threshold and switch their coverage to the federal program. And unlike the billions and trillions bandied about in our era, 10,000 isn’t impossible to picture. Just two … Read more

Walnut-sized device uses spring-loaded microneedles The FDA has awarded 510(k) clearance to a new blood-collection device called TAP (Seventh Sense Biosystems). The walnut-sized device attaches to the patient’s arm with an adhesive strip, and uses a ring of 30 spring-loaded microneedles to puncture the skin and withdraw 100 mcL of blood—enough for most blood tests. … Read more

Pharmacy benefits managers (PBMs) served notice last week that they refuse to be labeled as bad guys because of soaring drug costs. Prime Therapeutics today served notice that it wants to go even further: They’re the good guys. The PBM announced that it held the overall drug spending increase to just 2.5% last year. But … Read more

A CONVERSATION WITH HOWARD J. BERMAN Boards and managers need to perform better for this sector to continue offering the best care to those who might otherwise fall through the cracks. Howard J. Berman believes in not-for-profit health care. He spent the last two decades building what is now Lifetime Healthcare, the largest not-for-profit health … Read more

Health Care From the Medical Director POV FRANK DIAMOND Steve Miller, MD, now at Cigna, and Alan Adler, MD, recently retired from Independence Blue Cross in Philadelphia, reflect on their roles as medical directors and the current state of American health care. The C-Suite is Still Mostly a He-Suite SUSAN LADIKA The gender imbalance in health … Read more

Studies on the disparities in remuneration between primary care and other physician specialties are many, but a new study boils the differences down to the wages-per-hour level. The Center for Healthcare Policy and Research at the University of California–Davis compared wages across broad and narrow categories of physician specialists from data collected in the 2004–2005 … Read more

Florida Blue Tells Folks To Step Right In, Feel at Home Retail stores offer “young invincibles” and the working poor the chance to examine low-cost coverage options Officials at Blue Cross & Blue Shield of Florida didn’t plan for this. They couldn’t have. They launched their Florida Blue stores in 2007, well before it was … Read more

Heart disease has had the scary title of being the country’s number one killer for decades, but cancer is hard on its heels. According to the National Vital Statistics Report data for 2013 (the latest year available), the age-adjusted death rate for heart disease was 169.8 per 100,000. Cancer was just a smidgen behind, at … Read more

The field of personalized medicine has made significant progress with key discoveries like single nucleotide polymorphism and microarray/biochips. These advances will benefit plans, patients, the pharmaceutical industry, and society. Daniel Pucheril and Smiriti Sharma Both authors are MD/MBA candidates at Thomas Jefferson University, Philadelphia. Introduction The notion of individualism is strong within Western societies. During … Read more

John Garamendi, California’s insurance commissioner, thinks some insurers have the potential to gouge the consumer, and wants to mandate a high medical loss ratio John Carroll John Garamendi has long been a thorn in the side of the managed care industry in California. The state insurance commissioner has not only wrested multimillion-dollar agreements for free … Read more

This fresh treatment comprises the exact monoclonal antibody as Intra-Venous Rituxan® (rituximab) in conjunction with hyaluronidase individual, a molecule which helps to supply rituximab under skin. “With the current acceptance of RITUXAN HYCELA, individuals with three of those Many frequent blood cancers finally have a brand new treatment option which offers efficacy related to intravenous … Read more

By David Volz You’ve heard the pitch: Frustrated by their increasing inability to control the climate in which they must practice, physicians can find a happy haven by selling out to one of the burgeoning physician practice management companies for cash and a guaranteed annual salary. That way, they can concentrate on practicing medicine. What’s … Read more

Insurance industry executives from Anthem, UnitedHealth, Health Net, Kaiser Permanente and Aetna, along with California insurance commissioner Steve Poizner, have joined to ensure that patients can transfer their personal health records (PHRs) between insurance companies. A PHR is a tool used to manage an individual’s medical information. Nearly all insurers offer PHRs, but few patients … Read more

The momentum in managed care has shifted to for-profit plans, but don’t count out not-for-profits, particularly these three innovative and — for many enrollees — beloved HMOs. They aren’t resting on their laurels. Bob Carlson They were providing managed care before anyone called it that. But to make it through the turbulent late 1980s and … Read more

Primary care physicians’ compensation continues to decline, according to the American Medical Group Association’s 2003 Medical Group Compensation and Productivity survey. Over the past year, internists, pediatricians and adolescent medicine physicians, pulmonologists, emergency care physicians, ophthalmologists, and pathologists got the short end of the compensation stick. “This is not a trend that is going away,” … Read more

Premier Health is Departing the Ohio medical health insurance market place, mentioning uncertainty amid national discussion into this long term of Obamacare. The business announced Thursday that the Premier Health Plan will eventually end its on-exchange plan by the close of 2017. The Business was assessing Its potential on the market, where it was an … Read more

Having employer-sponsored benefits does not guarantee good service. Differences in race, education, and income are also factors. As employees at Kellogg, in Memphis, submitted to fingerstick cholesterol screenings and picked up health pamphlets at the cereal company’s annual health fair last month, many also for the first time talked with on-site researchers about their race, … Read more

Three tiers or four tiers are the drug benefit designs of choice among employers looking to rein in costs, according to findings presented in the Pharmacy Benefit Management Institute’s Pharmacy Benefit Cost and Plan Design Report. From 2007 to 2008, the percentage of employers who implemented a three-tier plan design with copayments rose from 45.3 … Read more

Data support new drug application by end of 2016 Positive results have been reported from a pivotal phase 3 study of an investigational once-daily closed triple combination therapy consisting of fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI, GlaxoSmithKline/Innoviva, Inc.)––a combination inhaled corticosteroid, long-acting muscarinic antagonist, and long-acting beta agonist––in patients with chronic obstructive pulmonary disease (COPD). … Read more

Effect of Patient Medication Cost Share on Adherence and Glycemic Control Jacquelyn Hunt, PharmD, MS, BCPS ; Yelena Rozenfeld, MPH ; Rahul Shenolikar, BS Pharm, PhD Higher cost sharing decreases adherence to oral diabetes drugs and worsens glucose levels Evaluating the Tools Used to Assess the Medical Home Rebecca A. Malouin, PhD, MPH ; Barbara Starfield, MD, MPH ; Martin Jose Sepulveda, MD … Read more

John Marcille Timothy J. Stezzi — Tim to those who know him — created this publication 21 years ago and now goes into well-deserved retirement. I think. Tim is the sort of guy who is likely to start another enterprise from scratch, or run for office, or decide that his considerable skills might be worth … Read more

Escalating premiums, changing attitudes play a role in employers’ decision to take on the same thing that burned many physicians: financial risk. Sharon Baker Rapidly rising health care costs, along with the desire to gain more flexibility and control over their health plan offer ings, are leading more companies to self-fund their HMO plans. Although … Read more

Payers Can Successfully Navigate Mergers and Acquisitions In the first of several posts, Tom Ewers and Munzoor Shaikh of West Monroe Partners discuss the dynamics of health care payer mergers. Here, they describe how success hinges on several key ingredients in the stages before closing — the pre-close stage. For health care payers, pre-close homework … Read more

Limiting residents’ work hours has no effect on patient safety, one study suggests — even though improving safety was one of the main reasons the limits for physicians-in-training were instituted in the first place. “In the year after implementation of the 2011 work-hour reforms, we found no change in ICU admissions, inpatient mortality, 30-day readmission … Read more

Health insurance plans need only bolster the following accepted guidelines to see a return on a very little bit of investment Bob Kirsch Heart failure results in substantial morbidity, mortality, and health care expenditures. There are 5.8 million people in the United States with heart failure, and this condition has one of the highest rates … Read more

“The doctor can see you this afternoon” may become the typical response when a patient calls for a same-day office visit. California leads the way. Cindy Ehnes knows firsthand how frustrating it can be when you are trying to arrange medical care for a family member but can’t even get an appointment with a physician. … Read more

Six Decades ago, National health officials were Convinced they could Save taxpayers billions of dollars yearly by auditing private Medicare Advantage insurance coverage that supposedly overcharged the federal government for services. A first form of Tests discovered that Medicare had possibly Over-paid five of their plans $128 million in 2007 independently, in accordance with private … Read more

Tennessee Gov. Don Sundquist wants a $400 million tax increase, much of which would keep TennCare, the state’s managed Medicaid program, from “imploding” — as put by its director, Brian Lapps. An actuarial study found that TennCare, which covers nearly a fourth of the state’s residents, is $289 million underfunded. Lapps says TennCare needs to … Read more

Outpatient treatment costs for psoriasis are estimated at $1.6 to $3.2 billion annually. In the commercial managed care population, psoriasis treatment consumes about $7 per member per year (PMPY), including prescription drugs and physician services. The potential market for new biologic agents is significant. If all patients with moderate to severe disease were treated with … Read more

Americans spent 34 percent more for specialty anti-inflammatory agents used to treat rheumatoid arthritis in 2005 than any other specialty drug category. The specialty anti-inflammatory class had the highest per-member per-year (PMPY) expense of all specialty classes, according to the Specialty Drug Trend Report from Express Scripts. The class, comprising four agents — Enbrel, Humira, … Read more

Jack McCain Tweet Widget(link is external) Long-acting reversible contraceptives (LARCs), which include intrauterine devices (IUDs) and subdermal implants, are the most effective method of contraception currently available, with failure rates comparable to those of male (vasectomy) or female sterilization (tubal ligation, fallopian tube inserts). LARCs are an easy contraceptive method to use. Once a LARC … Read more

A consultant urges plans to streamline Web sites and devise new contracting strategies to prepare for an influx of individual customers Health care reform will lead individuals to purchase their own coverage in greater numbers than the Congressional Budget Office predicts, and that will mean major changes and new opportunities for the insurance industry, says … Read more

Last year, the Bureau of Labor Statistics, the statistical arm of the Department of Labor, estimated that pharmacist employment was expected to grow by 22 percent between 2006 and 2016. This year, the forecast is somewhat lower, but still hopeful. The BLS reports that pharmacist employment is expected to grow by 17 percent between 2008 … Read more

At a presidential election where the elevated price of prescription medication was a significant campaign issue, JAMA combined the fray having a specific dilemma on medication prices. — combined with a small number of editorials dig deeper to key questions in regards to this U.S. pharmaceutical industry: Why is pharma earning too much income? Does … Read more

THE PARTICIPANTS: Mervin Shalowitz, M.D., president of the Medical Care Group in Skokie, Ill., and professor of medicine at Rush Medical College in Chicago. He is the moderator. Maribeth Capoleto, director of federal relations and assistant administrator of government programs for Group Health Cooperative of Puget Sound in Seattle. Alan Hillman, M.D., associate dean for health services research … Read more

Not surprisingly, many uninsured adults either do not get or postpone care they need. But a recent Kaiser/Commonwealth Fund survey suggests that adults who receive Medicaid benefits also skip or put off care — and that, because of expense, adult Medicaid patients are less likely to fill prescriptions than those without insurance — despite the … Read more

M.D., ends his three-year stint as Texas health and human services commissioner this month to become a consultant. McKinney oversaw policy, planning and budget matters for 11 state agencies. In announcing his resignation, McKinney said he was proudest of three achievements: integrating eligibility systems for 30 health and human service programs, including Medicaid; converting the … Read more

Michael S. Victoroff, M.D. An interesting drug trial has just concluded in my community. The case involves Bill Romanowski, linebacker for the Denver Broncos. Reportedly, Romanowski felt some phentermine would help him perform better in his job, and he was shy about this becoming public knowledge. Like many people (not just public figures), he wanted … Read more

Issue Space Commitment Run-of-Book Inserts January 12/10 12/22 12/29 February 1/9 1/22 1/30 March 2/10 2/23 2/27 April 3/10 3/16 3/20 May 4/10 4/22 4/28 June 5/11 5/22 5/29 July 6/10 6/22 6/30 August 7/10 7/22 7/30 September 8/10 8/21 8/28 October 9/10 9/22 9/30 November 10/10 10/22 10/26 December 11/10 11/22 11/26 Paul LendnerPaul … Read more

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 … Read more

Angela Braly has conducted the 2nd largest health insurance from the U.S. as 2007, affecting the fitness of just one in nine Americans. With assistance from this”fully engaged” plank after unsatisfactory earnings, the Braly is pushing imports to capitalize on healthcare reform and diversify well-point’s revenue flows. She consented to obtain health insurance Amerigroup at … Read more

As managed care’s share of a metropolitan market grows, hospitalization costs are more tightly controlled and hospital lengths of stay come down. That’s what common sense suggests, and that’s what a recent study bears out. But there are anomalies. In Milwaukee and Miami, for example, higher-than-average hospital costs coexist with fairly heavy managed care penetration. … Read more

Health care programs such as Medicare and Medicaid figure to suffer, thanks to a growing federal budget deficit, according to a report by the Congressional Budget Office. Political fingerpointing has already begun and the issue promises to be a hot one come the fall mid-term elections. The CBO estimates that the national deficit will exceed … Read more

Providers and payers are being asked to tackle the ‘upstream’ causes of poor health. Medicaid managed care organizations are being asked to screen enrollees for social needs. Some targeted efforts have translated into cost savings and make sense in value-based arrangements. But are we asking the health sector to take on too much? Andrew Renda, … Read more

High-deductible health plans: in the news and on the minds of researchers. Before us, two studies, one from UnitedHealth Group, the other from the Commonwealth Fund and the Baruch College School of Public Affairs at City University of New York.The latter, published in the July-August issue of Health Affairs, wants everyone to curb his enthusiasm … Read more

In a move to reflect the latest scientific thinking, the National Committee for Quality Assurance (NCQA) is revising six measures, retiring two measures, and adding one measure to the newest edition of the Healthcare Effectiveness Data and Information Set (HEDIS), known as HEDIS 2011, volume 2. “The driving force for these revisions is to help … Read more

PPOs are increasingly looking to managed pharmacy programs to help manage drug utilization costs of members with chronic conditions who are taking numerous medications. In general, the larger the PPO (number of members), the more likely it is to use a managed pharmacy program. The Sanofi-Aventis Managed Care Digest Series — HMO-PPO Digest 2010-2011 suggests … Read more

Improving physician behavior probably ranks somewhat lower on hospital priority lists these days than getting ready to avoid penalties for early readmissions, which are mandated by the Affordable Care Act. A study by IMA Consulting says that many hospitals are still not prepared to deal with this. The study cites the Centers for Medicare & … Read more

National reference facility for C1-INH-HAE. 167 patients using demonstrated identification of C1-INH-HAE, that reported data about angioedema strikes, for example seriousness, localisation and interval, treatment received, and usage of different healthcare solutions. Attacks were medicated using icatibant, plasma-derived C1-INH or simply encouraging maintenance. Treatment efficiency in reducing attack length and also the direct expenses of … Read more

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 of literature indicating … Read more

Annual revenue: $14.4 billion Health care benefits: $200 million annual cost, including coverage of 30,000 U.S. employees, 67% of whom are enrolled in HMOs, 15% in point-of-service plans, 6% in fee-for-service and 12% in alternatives. Favored philosophy: “Continuous quality improvement” Key initiative: Publishing a volume spelling out what it requires from HMOs it contracts with Distinctive strategy: For behavioral health … Read more

Key points Most of the current hospital performance measures do not identify the relationship between quality and cost of care and, therefore, are not health care efficiency measures. Current measures of physician efficiency do not identify the relationship between quality and cost of care. They should be considered cost-of-care measures, not health care efficiency measures. … Read more

A collection of articles from MANAGED CARE magazine 2002 Managing the Drug Benefit: One Company’s Experience The pharmacy director of Blue Cross of Oklahoma shares his company’s success with using three tiers and coinsurance to promote member responsibility. [July 2002] Third-Party Payers Don’t Realize Burdens Placed on Pharmacists PBMs and HMOs, by imposing a workload that doesn’t allow … Read more

THE FORMULARY FILES PCSK9 inhibitors on the way Krishna Rutvij Patel, PharmD Think Sovaldi’s causing headaches? Hepatitis C isn’t the only disease where dramatic treatments, and the vexing coverage decisions that come with them, occur. PCSK9 inhibitors for dyslipidemia are poised to enter the market next year. Amgen filed for FDA approval for its PCSK9 … Read more

A long-term follow-up study of chronic heart failure patients treated with cardiac contractility modulation (CCM) has been published online in the International Journal of Cardiology. Those receiving CCM experienced significantly improved long-term survival compared with matched patients who did not receive CCM. In the analysis, 41 heart failure patients treated with CCM were followed for … Read more

Determining the Cost-Effectiveness of a Computer-Based Smoking Cessation Intervention in Primary Care The Appropriate Omalizumab Patient Management of the uncontrolled asthma patient and case examples Applying the Planned Care Model To Intimate Partner Violence Implementing what was formerly called the Chronic Care Model can improve an organization’s response to this widespread problem The Use of … Read more

Year:  2011  |  2010  |  2009  |  2008  |  2007  |  2006  |  2005  |  2004  |  2003  |  2002  | 2003 January Cover Story Quality Counts: So Why Not Offer Physicians Bonuses? Changing Medical Evidence Brings Shift in C-Section Stance Getting Serious About Generics Digitally, the VA Leads the Way Peer-Reviewed The Quandary of Compounding for MCOs: Administrative Costs, Risks, and Waste Full contents … Read more

Although widely used in health care, pay-for-performance (P4P) incentives have resulted in only modest improvements, says a new study. Rand Corp. explores seven design features that could improve P4P programs — features that primarily rely on changing physician behavior. “Pay-for-performance programs are designed in a number of ways. One of the common designs provides physicians … Read more

9 Things Health Plans Must Do To Meet the ACA Challenge Timothy Kelley Delayed deadlines don’t alter the reality that you need to be ready for the big changes DSM-5 — Back to the Drawing Board? Susan Worley Mental illnesses are being redefined as science advances, but don’t believe reports of a war between the … Read more

More consumers on HMO and integrated-system boards might not bring the benefits that advocates expect, yet some plans do find them helpful. MargaretAnn Cross When she became a retiree, Jean Jantzen never thought she’d have to fly home from a truncated vacation to take care of a pressing corporate matter. But earlier this year, Jantzen … Read more

Public Reporting and payment programs from america have adopted thirty-day Re Admissions within a sign of between-hospital version in the standard of maintenance, even though limited evidence confirming this period. We analyzed risk-standardized thirty-day danger of esophageal readmission at a medical facility amount to Medicare patients ages sixtyfive and elderly at four countries and also … Read more

Lobbying state legislatures pays off for physician groups, and now health plans must provide more detail on who leases their networks For almost a decade, the American Medical Association has set its sights on eliminating what it sees as a thorn in the sides of doctors around the country — one state at a time. … Read more

Billion toward controlling the spread of this Zika virus, also a primarily mosquito-borne disorder that’s increased public health alerts. To maintain the government running before Dec. 9. It functions since the virus which could lead to birth defects if contracted by elderly women — is spreading in Florida. And, in the public health Perspective, just … Read more

The number of people who lost health insurance coverage because of layoffs could not be offset by an increase in the number of those using COBRA. This led to a relatively small increase in premiums for 2010. Apparently, however, that’s going to change in the next several years, say authors of a study titled “Health … Read more

Too often, the patient doesn’t learn — or doesn’t remember — important things that can speed recovery When Ted Eytan, MD, treats a patient with a broken rib, he positions the computer screen in the exam room so that his patient can look at the X-ray. He describes what the image shows, then clicks to … Read more

Red states aren’t the only ones that might seek ACA waivers John Carroll When Peter Shumlin was running for governor of Vermont last fall, the Democrat vowed to create a single-payer health care system that would replace the employer-based benefit that provides coverage for a majority of the state’s residents. Now that he’s in office, … Read more

The generic drug market seems ready to explode, according to reports from IMS Health and the Generic Pharmaceuticals Association. They estimate that the industry will grow by 13 percent in 2006. In 2005, more prescriptions were filled with generic drugs than with brand name products — 56 percent to be exact. Generic market share is … Read more

Adverse selection, other problems may hinder the presumptive Democratic candidate’s proposal to let people buy into Medicare in their 50s. Bernie Sanders’ erstwhile presidential bid has been credited—or blamed, depending on your perspective—with making Hillary Clinton tack to the left on some issues, most notably health care. And it may have worked—at least in the … Read more

FDA Handling of Avastin Discourages Innovation Robert M. Goldberg is a co-founder and vice president of the Center for Medicine in the Public Interest (CMPI). Robert M. Goldberg, PhDThere has been a lot of discussion of the Food and Drug Administration’s decision to revoke approval for the use of Avastin in metastatic breast cancer. Most … Read more

Deciding whether CAR T cell therapies is likely to soon be covered under Medicare. The bureau said Friday it had postponed its national policy decision for CAR-Ts, quoting an undercover CMS spokesperson as saying it wouldn’t be devoting the conclusion for CAR T cell therapy on Friday, but a decision was imminent. It submitted an … Read more

Also available as PDF One of the effects of managed care is greater responsibility for all participants in the health care industry — not just physicians. Hospital & Healthcare Compensation Service recently surveyed 195,410 employees of 381 hospitals in the nation to measure salary trends for nurse practitioners and physicians assistants for its Hospital Salary … Read more

Many states use the proceeds from conversions of not-for-profit Blue Cross Blue Shield health plans into for-profit companies to set up foundations for the uninsured. Now, consumer advocates worry that this practice may be jeopardized thanks to New York’s decision to use the cash from one such deal to shore up the state budget. The … Read more

U.S. government Bureaus Who had largely Overburdened Surgeries for Five weeks throughout a funding standoff said on Saturday that they were moving fast to restart operations and compensate employees for paychecks. Department financial officials late Friday to go over the resumption of government operations, while bureaus begun to deal with a back log of policy … Read more

Proceedings of the 12th Annual Symposium for Managed Care Professionals KEYNOTE Health Status, Health Maintenance, and Health Care in the 21st Century Louis Sullivan, M.D. President, Morehouse School of Medicine; Secretary, U.S. Department of Health and Human Services, 1989–1993 PANEL DISCUSSION Health Care Reform: Payor, Provider, Patient PANEL DISCUSSION Health Care Reform: The Consumer’s Viewpoint … Read more

Supply meeting demand isn’t always good. We watched for years as young doctors displayed less and less interest in primary care. They’re only human, after all. An income difference between primary care physicians and specialists that can be measured in hundreds of thousands of dollars is difficult to ignore. That’s why the point made by Barbara … Read more

Steven Peskin, MD A close friend of ours went with my wife to see a highly regarded physician for a persistent problem. This master clinician started with a warm greeting and a brief conversation about family, and then went through a detailed history of the problem that our friend had experienced for several months. He … Read more

COMPENSATION MONITOR Color charts Also available as PDF That seems to be the message for primary care physicians in data collected by the Medical Group Management Association, in a survey of 1,600 practices representing 30,000 physicians. MGMA found that practices in 1998 that saw increases in capitation revenue also rode “predictable” compensation-level curves. Family practitioners … Read more

A device hardly larger than an Rx pad may fare better than earlier versions of electronic prescribing. Vendors say learning to use them is a snap. By Ed Rabinowitz The first computers were huge, often large enough to fill an entire room. Then came the personal computer — small enough to sit atop a desk, … Read more

For much of the last decade, providers and payers have been trying to figure out how to make ACOs work and deliver on the promises of value-based care. The results? Let’s call them mixed to middling. Now, with a new decade starting, it may be direct contracting’s turn to be the great hope. Just before … Read more

Fundamental differences in program structure between Medicare and the Veterans Health Administration make drug pricing negotiations problematic We learn on the playground that empty threats are pointless, even dangerous. That’s how some analysts view the possibility of the federal government negotiating Medicare Part D drug prices: virtually a waste of time, but potentially damaging to … Read more

Companies are decreasing their share of premiums. It remains to be seen how this will affect workers’ health status. Martin Sipkoff Pogo’s observation, “We have met the enemy, and he is us,” seems true about the crusade to control health care cost. It’s a Herculean battle with ourselves. Hercules fought the shape-shifting Proteus, whose own … Read more